;940 
f.569m 
1901 


Presented  by 
William  F.  Madsen,  D.   0. 


COLLEGE   OF  OSTEOPATHIC    PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


Dr.   William    F.  MadseH 

610   South    Euclid    Avenue 

Pasadena,    California 


A  \MANUAL  OF 


Osteopathic 

Manipulations 

Treatment 


. . .  BY. »  J 

WILFRED  L.  RIGGS,  D.  O. 

AUTHOR  OF  THEORY  OF  OSTEOPATHY 

Formerly  Dean  and  Professor  of  Physiology  and  Lecturer  and  Dem- 
onstrator on  Theory  of  Osteopathy  in  Still  College  of  Osteop- 
athy and  Member  of  the  Examining  and  Operating  Staff 
of  theS.  S.  Still  Infirmary;  Demonstrator  in  Clinics 
Still  College;  Member  and  Trustee  A.  A.  A.O.; 
Professor  of  Science  Idaho  State  Normal. 


ELKHART,  INDIANA 

New  Science  Publishing  Company 

...1901... 


Copyright  1901 

By 
New  Science  Publishing  Co. 


A  MANUAL  OF 

anil 


Treatment 


TO 

All  who  labor  in  the  realm  of  drugless  medicine,  and  who  im- 
plicitly trust  to  the  efficiency  of  a  perfect  anatomical  arrangement 
to  secure  and  maintain  health,  this  little  volume  is  dedicated  by 

THE  AUTHOR 


(A/ 


PLATE  PAGE 

1.  Relaxing  the  Spinal  Muscles 14 

2.  Relaxing  Muscles  of  the  Neck 19 

3.  Raising  the  Ribs 23 

4.  Spinal  Extension 27 

5.  Relaxing  Muscles  of  Shoulder 31 

6.  To  Set  the  First  and  Second  Ribs 35 

7.  Relaxation  of  the  Lumbar  Region 39 

8.  Neck  Extension 43 

9.  Springing  Spine  Forward 47 

10.  Correcting  a  Lower  Dorsal 51 

11.  Correcting  a  Lateral  Dorsal 55 

12.  Correcting  an  Anterior  Dorsal       59 

13.  Setting  a  Dislocated  Rib 63 

14.  Raising  the  Clavicle 67 

15.  Bias  Stretch 71 

16.  Correcting  Posterior  Vertebra 75 

17.  Relaxing  Muscles  of  Shoulder 79 

18.  Setting  Eleventh  or  Twelfth  Rib 83 

19.  Treatment  of  the  Liver 87 

20.  Stretching  the  Sciatic  Nerve 91 

21.  Treating  the  Fifth  Nerve 95 

22.  Treatment  of  Ninth,  Tenth  and  Eleventh  Nerves . .  99 

23.  Stimulating  the  Liver 103 

24.  Correcting  a  Lateral  Cervical 107 

25.  Inhibiting  the  Abdominal  Plexuses Ill 

26.  Setting  an  Atlas 115 

27.  Setting  a  Sacro-Iliac  Clip 119 

28.  Correcting  an  Upper  Dorsal 123 

29.  Relaxing  Structures  at  the  Saphenous  Opening. . .  127 

30.  Correcting  a  Lateral  Dorsal  Vertebra 131 

31.  Stretching  the  Pyriformis  Muscle 135 

32.  Turning  a  Rib  Upward 139 


Preface* 

THERE  has  long-  been  a  need  among-  students 
and  practitioners  for  a  manual  of  movements 
used  in  Osteopathic  practice.  This  work  in  no  way 
supplies  the  place  of  a  practice  of  medicine,  but  it 
does  include  in  a  complete  and  yet  concise  manner 
all  that  is  peculiarly  osteopathic  in  the  diagnosis  and 
treatment  of  disease. 

The  manipulations  are  those  which  the  author 
has  tried  and  knows  to  be  effective;  no  experimental 
movements  are  given.  The  book  is  not  intended  for 
the  g-eneral  public,  but  it  supplies  a  particular  niche 
in  the  practice  of  Osteopathy.  These  treatments 
were  learned  from  four  sources,  viz:  The  Ameri- 
can School  of  Osteopathy,  Kirksville,  Mo.;  the  Still 
Colleg-e  of  Osteopathy,  Des  Moines,  Iowa;  the  prac- 
titioners in  the  field;  and,  from  actual  experience 
in  practice.  THE  AUTHOR. 


Introduction. 


T  IFE  is  a  reaction.  Its  basis  is  three-fold:  Mind 
* — '  which  directs  it;  physical  organization  which 
makes  it  possible;  and  the  chemical  chang-es  which 
accompany,  and  are  a  part  of  all  its  processes.  The 
body  is  a  machine  for  the  transformation  of  energy. 
By  its  subtle  chang-es  the  latent  force  of  the  food  is 
converted  into  the  hig-hest  type  of  human  energy. 
The  quantity  and  quality  of  this  chang-e  determines 
the  individual.  The  completeness  of  the  chang-e 
and  the  proper  distribution  of  the  energy  determine 
the  health  of  the  individual.  This  energy-machine 
must  be  in  perfect  order,  else  there  will  be  inter- 
ference with  both  the  quality  of  the  chang-e  and  its 
distribution,  either  of  which  conditions  is  abnormal. 
All  life  processes  are  effected  throug-h  motion. 

The  lymph,  the  blood,  all  the  fluids  of  the  body, 
the  tissues,  require  to  be  kept  constantly  moving-. 
Cessation  of  motion  means  imperfect  chang-es,  sub- 
oxides,  stag-nation,  death.  To  meet  these  condi- 
tions Osteopathy  offers  the  following-: 

First.  Correction  of  sub-luxations,  luxations,  and 
contractures. 

Second.  Removal  of  all  irritations,  central  or 
peripheral,  affecting-  the  nervous  system. 


10 

Third.  Removal  of  impediments  to  the  passage 
of  the  forces  and  fluids  of  the  body. 

Fourth.  A  perfect  method  of  increasing-  or 
decreasing  the  activity  of  the  glandular  tissues;  and 

Fifth.  Through  the  vaso-motor  system  a  perfect 
control  of  the  blood  supply  to  every  organ  of  the 
body. 

These  effects  are  based  upon  known  physiologi- 
cal laws.  There  is  no  empiricism  in  Osteopathic 
practice. 

Osteopathy  is  that  science  of  healing  which 
emphasizes  the  diagnosis  of  diseases  by  physical 
methods  with  a  view  to  discovering,  not  the  symp- 
toms, but  the  causes  of  disease;  and  treats  the  same 
by  manipulation,  the  purpose  and  result  of  which 
is  to  restore  the  normal  condition  of  nerve  control 
and  blood  supply  to  every  organ  in  the  body  by 
removing  physical  obstruction,  or  by  stimulating  or 
inhibiting  functional  activity  as  the  condition  may 
require. 


Osteopathic  Examination. 


ANY-  case  that  presents  itself  merits  an  exam- 
ination as  careful  as  can  be  made.  The 
urine,  the  sputum,  the  thorax  and  the  abdomen 
should  be  examined  according-  to  the  classic  meth- 
ods used  for  years  by  the  medical  profession. 
Anything  which  will  give  an  insight  into  the  con- 
dition of  your  patient  is  yours  to  employ,  and  you 
are  culpable  if  you  do  not  use  it.  But  there  is  a 
deeper  meaning-  to  the  word  palpation  than  is  com- 
monly applied  to  it.  That  meaning-  is  the  osteo- 
pathic  one.  True  palpation  is  par  excellence  the 
osteopathic  method  of  examination.  It  is  throug-h 
his  trained  touch  that  the  Osteopath  determines  a 
dislocation  of  bone,  a  tightening-  of  tendon  or  car- 
tilage, or  a  contracture  of  muscle.  These  are  the 
conditions  to  which  he  attributes  disease  in  many 
instances.  These  are  the  conditions  which  the 
Osteopath  corrects  in  his  treatment  of  readjust- 
ment. The  patient's  clothing  should  be  arranged 
so  as  to  allow  free  access  to  the  spine  and  to  the 
thorax. 

That  we  may  intelligently  examine  a  spine  we 
should  be  thoroughly  acquainted  with  the  general 
topography  of  the  back.  The  normal  spine  has 


12 

four  curves,  as  follows:  (1)  The  cervical,  concave 
backward,  extending  from  the  apex  of  the  odontoid 
process  to  the  second  dorsal.  (2)  Beginning-  at  the 
middle  of  the  second  dorsal  and  extending-  to  the 
twelfth,  its  concavity  forward,  is  the  dorsal  cnrvc. 
The  most  prominent  point  is  at  the  seventh  and 
eighth  dorsal.  (3)  The  lumbar  curve,  from  the 
middle  of  the  twelfth  dorsal  down  to  the  angle 
between  the  fifth  lumbar  and  the  base  of  the  sac- 
rum, its  concavity  being  directed  backward.  (4) 
From  the  base  of  the  sacrum  to  the  tip  of  the 
coccyx,  its  concavity  forward,  is  the  pelvic  curve, 

Care  must  be  taken  to  become  thoroughly 
familiar  with  the  normal,  in  order  that  any  varia- 
tion from  this  type  may  be  detected.  There  are 
variations  within  a  limited  range,  even  in  health. 
The  dorsal  and  pelvic  curves  are  primary  and  are 
due  to  the  shape  of  the  vertebrae,  while  the  cervical 
and  lumbar  are  secondary  and  compensatory  and 
exist  only  after  birth,  their  existence  being  due 
to  modifications  in  the  form  of  the  intervertebral 
discs. 

The  lumbar  curve,  beginning  at  the  sacro-verte- 
bral  articulation,  drops  forward  very  abruptly  and 
if  this  should  be  further  increased  in  appearance 
by  well  developed  nates,  the  physician  may  be 
deceived.  The  test  must  be  made  by  a  careful 
examination  for  tenderness  on  pressure.  The 
spines  should  lie  in  a  perpendicular  plane  while  the 


13 

patient  is  sitting-  or  standing-  erect,  thoug-h  there  is 
often  a  slig-ht  lateral  curvature  in  the  dorsal  region, 
the  convexity  of  which  is  directed  toward  the  hand 
which  is  habitually  used.  The  tips  of  the  vertebral 
spines  should  lie  in  a  perpendicular  plane,  which 
may  be  tested  by  bringing-  the  hand  briskly  down 
over  the  spines  either  directly  over  them  or  with 
two  fing-ers,  one  on  each  side  of  their  prominences. 
By  this  method  one  may  detect  any  deviation  from 
the  usual  position,  and  if  tenderness  be  present 
it  is  an  evidence  of  a  lesion;  and,  reasoning-  from 
cause  to  effect,  the  organ  or  org-ans  affected  may 
with  certainty  be  determined.  But  care  must  be 
used  in  the  matter  of  finding-  a  lesion.  The  atlas 
has  no  spine,  only  a  mere  tubercle  and  no  surprise 
should  be  manifested  at  finding-  it  "forward. "  The 
second  cervical  is  perhaps  the  most  prominent 
feature  in  the  cervical  region  of  a  normal  spine,  and 
its  widely  bifurcating-  and  massive  spinous  process 
may  give  the  beginner  some  uneasiness.  The 
cervical  spines  are  bifid j  from  the  second  to  the 
sixth  inclusive.  The  vertebra  prominens  is  close 
to  the  first  dorsal,  the  latter  very  commonly  being- 
mistaken  for  it. 

To  examine,  bare  the  spine,  have  the  patient  sit 
erect.  Note  the  curves,  whether  they  be  normal, 
diminished  or  accentuated.  A  flat  region  in  the 
upper  dorsal  means  lung- and  heart  action  impaired, 
and  weakened  vitality.  If  the  fifth  to  tenth  dorsal 


14 

are  anterior,  or  if  the  lumbar,  dorsal  and  cervical 
are  almost  in  line  there  is  stomach  or  intestinal  dis- 
order. Any  marked  deviation  from  the  normal 
curve  in  the  lumbar  region  may  result  in  constipa- 
tion, ovarian  or  uterine  disorder,  or  derangement 
of  the  function  of  the  bladder.  The  sacral  verte- 
brae are  relative  to  each  other  always  in  place,  but 
they  may  be  slightly  out  of  their  true  articulation 
with  either  the  auricular  processes  of  the  ilium  or 
with  the  lumbar  vertebra  above  or  the  coccyx 
below.  In  lesions  of  the  lumbo-sacral  and  sacro- 
iliac  articulations  you  will  find  pelvic  disturbances. 
The  coccyx  may  by  dislocation  cause  constipation, 
haemorrhoids  and  piles.  Detect  any  lateral  curves 
that  may  be  present  by  careful  inspection.  Fric- 
tion will  bring-  into  view  the  spines  and  any  marked 
separation  or  deviation  from  the  perpendicular,  the 
patient  sitting  erect,  should  call  for  careful  palpa- 
tion. 

Locate  the  second  cervical  by  its  prominence. 
The  first  dorsal  by  the  length  of  its  spinous  pro- 
cess. The  third  dorsal  by  the  level  of  the  scapular 

PLATE  1. 

Relaxing  the  Spinal  Muscles.  Patient  lies  face  down 
ward.  The  physician  places  his  hands  palm  downward  at 
the  level  of  the  first  dorsal  vertebra  near  the  spines.  Have 
patient  thoroughly  relax  all  muscles.  Now  press  with  the 
hands  upward  and  slightly  outward,  and  repeat  the  action 
at  the  spine  next  below.  Do  this  for  each  spine  in  succes- 
sion. The  greatest  pressure  will  be  needed  at  points  of 
muscular  contraction.  In  case  of  an  unusually  muscular 
patient  one  hand  may  be  placed  upon  the  other,  relaxing 
first  one  side  and  then  the  other. 


16 

spine.  The  seventh  dorsal  by  the  angle  of  the 
scapula.  The  fourth  lumbar  by  the  fact  that  a 
line  joining-the  iliac  crests  will  pass  through  its  body. 

The  twelfth  dorsal  may  be  conveniently  located 
by  having-  the  patient  fold  his  arms  and  lean  for- 
ward thus  throwing1  into  prominence  the  trapezii, 
whose  converging-  external  borders  will  indicate 
the  twelfth  spine;  or,  better,  by  the  articulation 
with  the  last  rib;  or,  by  the  natural  break  between 
it  and  the  first  lumbar.  After  being-  satisfied  with 
inspection,  a  careful  examination  with  the  hand 
will  detect  any  irreg-ularity  that  the  eye  may  over- 
look. The  spines  are  the  key  to  the  situation,  but 
tenderness  in  addition  to  abnormal  position  must 
be  found. 

Each  operator  will  have  his  preference  for  posi- 
tion of  the  patient.  For  a  thoroug-h  examination 
several  positions  may  be  necessary.  The  following- 
order  is  sug-g-ested,  the  back  being-  exposed  in  all 
cases: 

First.  Patient  sits  erect,  operator  standing- 
behind. 

Second.  Patient  leans  forward,  sitting-  squarely, 
hands  on  knees. 

Third.  The  patient  is  placed  facing-  operator, 
first  on  rig-ht  and  then  on  left  side.  The  operator 
carefully  examines  each  spine  and  transverse  pro- 
cess in  succession.  During-  this  examination  the 
patient  must  thoroug-hly  relax.  The  operator  uses 


17 

arms  and  leg's  of  patient  as  levers  for  movement  in 
examination. 

Fourth.  Patient  on  back,  body  straight  so  that 
nose,  chin  and  point  between  feet  are  in  straight 
line,  arms  at  sides.  The  operator  now  stands  at 
head  and  examines  both  sides  of  vertebrae  of  neck. 
The  spines  of  cervical  vertebrae  cannot  be  relied 
upon  for  diagnosis  so  we  examine  transverse  pro- 
cesses. Deviation  from  a  straight  line  either 
antero-posteriorly  or  laterally  indicates  trouble  at 
that  point.  An  examination  of  its  spine  will 
usually  confirm  this  result.  The  atlas  can  be 
examined  only  at  its  transverse  process  which 
should  be  easily  felt  about  half  way  between  mas- 
toid  process  and  the  descending  ramus  of  the 
inferior  maxilla.  Tenderness  is  usually,  if  not 
always,  most  pronounced  on  the  side  of  the  slip. 
The  end  of  the  little  finger  may  usually  be  passed 
between  the  transverse  process  and  the  ramus  of 
the  jaw  if  in  normal  position. 

The  following  facts  are  of  importance  in  locat- 
ing certain  structures. 

The  sixth  cervical  spine  is  opposite  the  cricoid 
cartilage  and  the  beginning  of  the  oasophagus. 

The  seventh  cervical  spine  is  at  the  level  of  the 
apices  of  the  lungs. 

The  eighth  thoracic  spine  marks  the  lowest 
level  of  the  heart  and  the  central  tendon  of  the 
diaphragm. 


18 

The  ninth  thoracic  spine  is  at  the  level  of  the  car- 
diac opening-  of  the  stomach. 

The  tenth  thoracic  spine  marks  the  lowest  level 
of  the  lung-s. 

The  eleventh  thoracic  spine  is  at  the  lower  border 
of  the  spleen  and  the  upper  border  of  the  rig-ht 
kidney. 

Thejirs/  lumbar  spine  is  at  the  level  of  the  renal 
vessels,  and  the  pelvis  of  the  kidney. 

The  second  lumbar  spine  is  opposite  the  recep- 
taculum  chyli  and  the  third  portion  of  the  duode- 
num. 

The  third  lumbar  spine  lies  just  above  the  umbil- 
icus. 

The  fourth  lumbar  spine  is  at  the  level  of  the 
aortic  bifurcation  and  the  iliac  crests. 

The  end  of  the  coccyx  marks  the  junction  of  the 
first  and  second  portions  of  the  rectum. 

PLATE  2. 

Relaxing  Muscles  of  the  Neck.  This  usually  follows  the 
relaxation  of  muscles  of  spine.  Standing  at  the  side  of  the 
patient  place  one  hand  on  the  patient's  forehead,  the  other 
on  the  muscles  of  the  neck.  Pressing  firmly  on  the  muscles 
bend  slightly  and  rotate  the  head  toward  you,  and  then 
reverse,  bending  and  rotating  in  the  opposite  direction. 
This  should  be  done  at  each  of  the  cervical  vertebra  in  suc- 
cession. This  should  be  followed  by  standing  at  patient's 
head  and  placing  the  hands,  one  on  either  side,  on  the  mus- 
cles along  the  transverse  process  of  the  cervical  vertebra. 
The  hands  lying  flat  the  neck  may  be  bent  from  side  to  side. 
This  treatment  should  be  given  at  each  vertebra  in  succes- 
sion, beginning  with  the  seventh.  The  above  movements 
will  thoroughly  overcome  muscular  troubles  in  the  cervical 
region. 


20 

The  spinal  nerves  have  their  origin  from  the 
spinal  cord  as  follows: 

The  eig-ht  cervical  nerves  come  from  the  spinal 
cord  above  the  level  of  the  sixth  cervical  spine. 

The  upper  six  dorsal  nerves  arise  between  the 
levels  of  the  sixth  cervical  and  the  fourth  dorsal 
spines.  The  lower  six  dorsal,  between  the  fourth 
dorsal  and  the  eleventh  dorsal  spines. 

The  five  lumbar  nerves  arise  between  the  levels 
of  the  eleventh  and  twelfth  thoracic  spines. 

The  sacral  nerves  take  origin  between  the  last 
dorsal  and  the  first  lumbar  spines. 


21 


Osteopathic  Centers. 


/^STEOPATHY  bases  its  claim  to  rank  as  a 
^-^  science  of  healing-  upon  the  fact  that  there 
exists  a  definite  and  fixed  relation  between  an  organ 
and  the  central  nervous  system.  This  relation  is 
secured  through  the  segmented  arrangement  of  the 
spinal  nerves  or  through  the  sympathetic  system, 
by  means  of  rami  communicantes.  The  order  of 
this  innervation  is  fairly  constant,  though,  as  in  the 
case  with  other  portions  of  the  body,  it  may  vary. 
This  variation  in  no  wise  invalidates  the  claim  of 
Osteopathy  to  rank  as  a  science,  but  it  emphasizes 
the  necessity  of  our  searching  for  lesions  even  in 
regions  relatively  remote  from  the  center.  Specific 
treatment  in  the  sense  of  work  exclusively  upon  a 
region  said  to  be  a  center  is  rarely  indicated.  Owing 
to  the  diffusion  of  pain  and  its  attendant  conditions, 
it  is  necessary  to  remove  any  contracture  which 
may  be  associated  with  it.  Again,  it  sometimes 
occurs  that  disease  of  an  organ  produces  no  effect 
on  its  usual  center,  and  in  such  an  event  it  is  neces- 
sary to  carefully  examine  other  regions  for  the 
trouble.  Know  the  location  of  the  centers.  Know 
also  that  occasionally  a  lesion  causing  the  trouble 


22 

must  be  found  elsewhere.  "Touching-  the  button  " 
is  fascinating1,  both  in  theory  and  in  practice,  but 
the  operator  must  be  broad  enoug-h  to  expect  it  to 
be  difficult  occasionally  to  locate  the  button. 

Our  use  of  the  term  center  is  in  the  sense  of  a 
convenient  and  advantageous  place  to  reach  fibres 
to  or  from  a  certain  organ.  We  now  point  out 
some  of  the  more  important  of  these  centers: 

The  atlas  is  associated  with  disturbances  to  the 
vaso-motors  of  the  eye,  ear,  and  with  eczema  and 
other  diseases  of  the  face. 

The  axis  and  third  cervical  is  a  g-eneral  vaso- 
motor  center,  throug-h  the  superior  cervical  gan- 
glion, and  also  a  center  for  side  of  head,  face,  eye, 
nose,  pharynx,  tonsils  and  vessels  of  the  brain. 

Third,  fourth,  and  fifth  cervical,  orig-in  of 
phrenics,  center  for  hiccoughs. 

Fifth  and  sixth  cervical,  middle  cervical  ganglion, 

PLATE  3. 

Relaxing  the  Muscles  of  the  Upper  Dorsal  Region,  and 
Raising  the  Ribs.  Patient  on  back.  Standing-  at  side  of 
patient's  head,  take  the  arm  with  your  corresponding-  hand 
and  place  the  other,  palm  upward,  beneath  the  shoulder, 
the  ends  of  the  fing-ers  flat  against  the  angle  of  the  rib.  The 
arm  is  now  pulled  upward  and  forward,  at  the  same  time 
the  patient  takes  a  deep  breath.  The  arm  is  continued  up- 
ward and  then  backward.  When  it  is  in  such  position  as 
to  throw  the  greatest  tension  on  the  rib,  the  patient  releases 
his  breath  and  the  arm  is  returned  to  his  side.  The  hand 
beneath  the  rib  must  continue  pressure  against  the  angle 
until  the  arm  is  returned  to  its  natural  position.  This 
is  effective  for  any  of  the  ribs  from  the  third  to  the  eight 
inclusive,  as  the  seventh  and  eighth  may  be  controlled 
through  their  sternal  attachments.  Two  operators,  one  on 
each  side,  may  give  this  treatment  to  good  advantage. 


24 

center  for  thyroid  gland,  also  augmentors  to  heart 
.  ttiroug-h  middle  cervical  gang-lion. 

The  general  function  of  the  cervical  region  is 
that  of  (1)  vaso-constrictor  effect  through  sympa- 
thetic fibres  passing  into  it  from  below  through  the 
second,  third,  fourth  and  fifth  dorsal,  and  vaso- 
dilator fibres  in  the  cervical  spinal  nerves,  thus 
affecting  all  parts  of  the  body;  and  (2)  local  vaso- 
motor  effects  on  the  neck,  head  and  face  of  the 
same  side.  That  the  upper  cervical  region  is 
sometimes  said  to  be  a  center  for  the  kidney  is 
based  upon  its  influence  over  the  general  vaso- 
motors  of  the  entire  body. 

Second  to  sixth  dorsal  are  vaso-constrictors  to 
the  pulmonary  blood  vessels. 

Third  to  seventh  dorsal,  vaso-motors  to  arm  via 
the  brachial  plexus. 

Seventh  cervical  and  first  dorsal,  inferior  cervi- 
cal ganglion,  heart,  thyroid  gland,  vertebral  and 
basilar  arteries. 

Annulus  of  Vieussens  and  second,  third,  fourth, 
and  fifth  dorsal,  augmentory  fibres  to  the  heart. 

The  first  three  give  regularity  of  rhythm. 

Fourth  and  fifth  control  regularity  and  strength 
of  beat. 

Fourth  dorsal,  sometimes  third  or  fifth,  stomach 
center  on  right  side  usually.  General  effect  as  low 
as  the  eighth. 

Second    and    third    dorsal,    center    for    ciliary 


25 

muscle.     Center  for  vomiting1.     Center  for  bron- 
chial tubes  and  bronchi. 

Sixth  to  tenth  dorsal,  origin  of  the  great 
splanchnic,  carrying-  viscero-inhibitory  fibres  and 
vaso-constrictor  and  secretory  fibres  to  the  stom- 
ach and  small  intestine. 

Eighth,  ninth  and  tenth  dorsal  on  right  side, 
center  for  the  liver.  This  gives  us  the  center  for 
chills,  as  the  liver  and  spleen  are  implicated  in 
malarial  attacks. 

Ninth  and  tenth  dorsal  on  the  left,  center  for 
the  spleen.  In  treatment  of  chills  the  general  con- 
dition must  be  controlled  through  cardiac  and 
vaso-motor  centers,  directing-  especial  attention  to 
the  liver  and  spleen.  Also  center  for  uterus  via 
hypogastric  plexus. 

Eleventh  and  twelfth  dorsal  and  upper  lumbar, 
the  small  intestine  and  kidney. 

Eleventh  and  twelfth  dorsal,  center  for  ovary. 

Second  lumbar,  center  for  parturition,  micturi- 
tion and  uterus. 

Second,  third  and  fourth  lumbar,  center  for 
diarrhoea. 

Fourth  and  fifth  lumbar,  hypogastric  plexus, 
which  with  fibres  from  the  aortic  plexus  forms  the 
pelvic  plexus,  distributing  fibres  to  the  pelvic 
organs. 

The  anterior  division  of  the  sacral  nerves  are 
splanchnic  in  function  and  are  distributed  to  the 


26 

rectum,  to  the  bladder,  sphincter  ani,  vagina  and 
uterus.  These  seem  to  be  chiefly  viscero-motor 
in  function. 

Second  and  third  sacral,  bladder. 

Fourth  sacral,  vagina. 

Fourth  and  fifth  sacral,  sphincter  ani. 

After  a  general  view  of  the  centers  along  the 
spine  it  is  necessary  to  form  a  resume  of  their 
location  by  mentioning  the  chief  organs  of  the  body 
and  with  them  the  regions  in  which  they  may  be 
affected  through  their  vaso-motor,  viscero-motor, 
inhibitory  and  secretory  nerve  supply.  Generally 
speaking  the  circulation  is  controlled  through  the 
great  vaso-motor  centers,  reached  in  the  upper 
cervical  region.  It  is  further  controlled  through 
the  region  from  which  the  augmentor  fibres  make 
their  exit — the  second  to  the  fifth  dorsal.  It  is  also 
affected  by  treatment  in  the  splanchnic  region  con- 
trolling the  vaso-motors  to  the  great  capillary  net- 
work of  the  mesenteries. 

In  case  of  a  disturbance  in  any  of  the  following 
organs  or  members  look  for  your  spinal  lesions  as 
follows: 

PLATE  4. 

Spinal  Extension.  Patient  on  back.  Reach  over  arms  as 
in  the  plate.  The  ankles  should  be  held  by  an  assistant  or 
else  fastened.  The  physician  takes  hold  at  angles  of  ribs 
and  pulls.  The  body  may  be  slightly  rotated  and  also 
swung  from  side  to  side.  This  is  an  excellent  treatment  for 
the  spine  in  contractures,  nervousness  and  curvatures.  It 
should  never  be  omitted  in  the  last  named  condition. 


28 

Eye:  Atlas,  third  cervical  and  second  or  third 
dorsal. 

Ear:  Second  to  fifth  cervical. 

Brain:   From  first  cervical  to  first  dorsal. 

Pharynx,  larynx  and  tonsils:  Second  and  third 
cervical. 

Thyroid  gland:  Fifth  and  sixth  cervical,  general 
vaso-motor  and  cardiac  center;  seventh  cervical  and 
first  dorsal — head  of  first  rib,  clavicle. 

Arm,  motion,  vaso-motor  and  nutrition:  Brachial 
plexus  in  fifth,  sixth,  seventh,  eighth  cervical  and 
first  dorsal;  also  vaso-motors  in  third  to  seventh 
dorsal. 

Lungs  and  bronchi:  Second  to  sixth  or  eighth 
dorsal;  also  vagus  nerve. 

Heart:  Fibres  from  second  to  fifth  dorsal, 
especial  attention  to  fifth  dorsal.  Heart  may  also 
be  reached  through  middle  and  inferior  cervical 
ganglion,  and  at  first  rib,  or  annulus  of  Vieussens. 

Stomach:  Third  to  fifth  dorsal  specific  on  right 
side;  third  to  eighth  generally;  also  vagus. 

Liver:  Ninth  and  tenth  dorsal,  vaso-motor,  vagus 
motor. 

Spleen:  Eighth  to  eleventh  dorsal,  vaso-motor, 
vagus  motor. 

Duodenum:  Great  splanchnic,  sixth  to  tenth 
dorsal. 

Jejunum  and  ileum:  Lower  dorsal  and  lumbar 
to  fourth,  and  fibres  from  solar  plexus. 


29 

Colon:  Second  to  fifth  lumbar;  also  fibres 
from  solar  plexus. 

Rectum:  Second  to  fifth  lumbar  via  inferior 
mesenteric  plexus,  inhibitory.  Sacral  via  hypo- 
g-astric  plexus,  motor;  also  third  and  fourth  dorsal. 

In  treatment  of  the  abnormal  viscera  in  addi- 
tion to  specific  treatment  it  is  always  beneficial 
to  give  direct  treatment  to  the  abdomen,  paying- 
particular  attention  to  the  region  of  the  solar  plexus. 
This  has  the  effect  of  changing-  the  blood  by  com- 
pression, thus  relieving-  venosity  and  allaying- 
increased  peristalsis;  or  in  case  of  slug-gishness  of 
any  org-an  it  stimulates  the  plexuses  of  Auerbach 
and  Meissner  to  motion  and  secretion.  It  may, 
also,  break  up  masses  of  fecal  matter  lying-  within 
the  abdominal  canal. 

Uterus:  Second  to  fifth  lumbar,  ninth  and  tenth 
dorsal. 

Genitalia  g-enerally:     Second  to  fifth  lumbar. 

Bladder:     Second,  third  and  fourth  sacral. 

Sphincter  ani:     Fifth  sacral. 

The  knowledg-e  of  the  location  of  these  centers  is 
of  incalculable  advantag-e  to  the  Osteopath  since  it 
is  upon  this  knowledg-e  that  the  accuracy  of  his 
diag-nosis  and  treatment  depends.  An  osseous 
lesion  in  the  area  which  we  have  desig-nated  as  a 
center  for  a  certain  org-an  may  lead  to  a  diseased 
condition  of  that  org-an;  while  a  lesion  of  an  org-an 
may  manifest  itself  in  tenderness  within  its  center 


30 

along-  the  spine.     This  tenderness  may  be  found  in 
the  following-  localities: 

First.  On  the  ends  of  the  spinous  processes, 
usually  indicating-  an  anterior  condition. 

Second.  Above  the  spinous  processes  and  about 
an  inch  lateral  at  the  articulation  of  the  rib  with 
the  transverse  process  of  the  vertebra,  indicating- 
a  lateral  movement  and  often  a  tipping-  forward  of 
the  body  of  the  vertebra. 

Third.  The  soreness  may  be  manifested  at  the 
ang-le  of  the  rib,  indicating-  a  rotation  of  the  rib 
upward  or  downward  on  the  axis  connecting-  its 
two  extremities. 

Fourth.  Associated  with  any  of  these  three  con- 
ditions may  be  found  soreness  in  the  muscles  lying- 
in  that  region  on  either  side  of  the  spinous  process. 

To  determine  these  conditions  the  patient  may 
be  sitting-  or  lying-. 

Gentle  pressure  will  determine  any  sensitive- 
ness. To  examine  the  angles  of  the  ribs  in  the 
interscapular  region  the  arm  on  the  same  side 
should  be  grasped  at  the  elbow  and  firmly  passed 

PLATE  5. 

Relaxing  Muscles  of  Shoulder.  The  first  position  is  shown 
in  plate  five.  The  elbow  of  patient  is  placed  against  some 
fixed  point  of  the  physician,  either  the  ribs  or  the  ilium. 
Push  with  the  body  against  the  elbow  and  press  toward  you 
with  the  hands.  By  moving  the  body  up  and  down  the 
rhomboid  and  the  levator  anguli  scapulae  may  be  alternately 
tightened  and  relaxed.  The  shoulder  and  scapula  should 
be  rotated  on  the  body,  one  hand  pressing  on  the  vertebral, 
border  of  the  scapula. 


32 

across  the  chest.  This  will  tighten  the  muscles 
and  expose  the  rib  from  the  covering-  of  the  scapula. 
In  all  these  cases  the  muscular  contraction  must  be 
released;  to  do  this  the  patient  should  be  placed 
upon  the  table  and  a  firm  and  steady  pressure 
applied  to  the  muscles,  the  skin  being  lax,  passing 
either  upward  or  downward.  This  will  release 
the  pressure  and  may  be  sufficient  in  acute  cases. 
In  addition  to  this,  an  oscillation  of  the  body  from 
side  to  side,  bending  at  the  lesion,  will  prove  helpful, 
as  "will  rotation  around  the  same  point.  Springing 
the  spine  forward  will  produce  a  good  effect  by 
releasing  muscular  and  ligamentous  contractures. 


33 


A  General  Treatment. 


osteopath  who  treats  all  cases  alike  is  not 
*•  in  any  sense  deserving-  of  the  name,  yet  there 
are  many  cases  in  which  it  is  helpful  to  administer 
what  is  known  as  a  "general  treatment;  "  as  when 
there  is  complaint  of  "ennui, "  lassitude  and  drowsi- 
ness, torpidity  of  g-lands,  weariness,  lack  of  circu- 
lation, loss  of  appetite  and  similar  conditions.  This 
is  the  most  easily  administered  of  osteopathic 
manipulations,  and  has  given  use  to  the  common 
belief  that  there  is  no  possible  harm  in  osteopathic 
treatments.  This  is  an  error.  A  general  treat- 
ment, if  given  gently,  produces  no  harmful  effect, 
but  if  incautiously  administered  by  one  ignorant  of 
the  science,  may  do  incalculable  injury. 

Proceed  as  follows:  First,  have  patient  (pre- 
pared by  removing-  clothing1  so  as  to  permit  spine 
to  be  exposed)  recline  on  table.  Relax  muscles  of 
neck  by  gently  rocking  head  from  side  to  normal 
position,  at  same  time  putting  pressure  with  other 
hand  upon  muscles  of  side  of  neck.  Do  this  for 
each  side.  Then  lift  patient's  head  in  one  hand 
and  put  pressure  on  muscles  on  back  of  neck. 
Repeat  this  three  or  four  times.  This  will  relax 


34 

the  muscles  of  neck  and  aid  in  equalizing-  the  cir- 
culation throug-h  the  cervical  sympathetics.  Next, 
with  patient  on  side,  using-  arm  as  lever,  press  upon 
muscles  of  the  spine,  beginning  at  first  dorsal  and 
g~oing  downward  through  each  region  of  the  spine 
successively.  This  is  done  for  both  sides.  The 
patient  next  lies  on  face,  the  arms  hang-ing  freely. 
Thorough  relaxation  is  necessary.  The  physician 
then  presses  strongly  upward  and  outward  on  the 
muscles  from  upper  to  lower  portion  of  spine. 
Patient  now  lies  on  back  with  legs  flexed.  The 
abdomen  is  kneaded  thoroug-hly,  following-  the 
course  of  the  colon.  The  regions  of  liver,  spleen 
and  pancreas  are  thoroughly  kneaded.  Lastly, 
spine  is  thoroughly  stretched  by  placing  patient  in 
"swing-"  so  feet  will  just  reach  the  floor,  then 
standing  behind  him  he  is  pushed  forward  or 
laterally;  or  patient  lies  on  back  and  an  assistant 
grasps  ankles  while  operator  takes  hold  of  the 

PLATE  6. 

To  set  the  First  and  Second  Ribs.  The  ribs  are  usually 
turned  upwards.  To  set  them,  thoroughly  relax  all  sur- 
rounding parts.  Then  draw  the  head  laterally  to  elevate 
the  rib  thus  exaggerating  the  condition.  Put  thumb  on 
head  of  rib  and  finger  on  middle  point;  now  bring  the  head 
back  and  up  to  normal  position  pushing  downward  as  the 
head  is  released. 

The  patient  may  sit  and  with  one  hand  on  the  rib  as 
above,  with  the  other  the  physician  may  grasp  the  arm  and 
pull  the  shoulder  downward,  pressing  on  the  rib  as  before. 
To  raise  the  first  or  second  ribs  the  physician  may  utilize 
either  the  scaleni,  pressing  upward  at  the  head  and  angle 
of  the  rib,  or  downward  as  in  the  previous  movement,  or  by 
pressing  upward  at  head  and  angle  of  rib  and  pulling 
upward  on  the  clavicle  he  may  secure  the  same  result. 


36 

shoulders  and  steadily  stretches.  The  value  of 
this  is  accentuated  by  steadily  oscillating  the  body 
from  side  to  side.  The  physician  may  place  palm 
of  one  hand  on  patient's  chin,  another  at  occiput 
and  stretch  as  before.  Use  care  in  this  treatment 
as  injury  may  be  done. 


TO    SET   A   RIB. 

All  osteopaths  agree  that  the  dislocation  of  a  rib 
is  of  frequent  occurrence.  To  correct,  first  deter- 
mine the  exact  nature  and  amount  of  the  dislocation. 
To  raise  vertebral  portion,  patient  lies  on  opposite 
side;  with  one  hand  grasp  patient's  arm  and 
forcibly  extend  it,  swing-ing  it  upward  across  face; 
at  same  time,  with  the  other  hand,  strong  pressure 
is  applied  at  head  of  rib  with  fingers  and  at  angle 
with  the  thumb,  presses  inward  and  upwrard.  The 
patient  strongly  inhales  as  the  arm  is  thrown 
upward,  then  the  arm  is  brought  do\vnward  and 
the  patient  exhales.  The  pressure  at  the  verte- 
bral portion  is  maintained  until  the  arm  is  returned 
to  its  normal  position.  (See  plate  17.) 


OTHER  METHODS. 

Position  same  as  above.  Place  patient's  elbow7 
against  your  abdomen  or  chest.  Reach  over,  and 
with  your  hands  free  ribs  from  vertebrae  by  pres- 
sure outward  on  angles.  Then  turn  them  upward 
or  do\vnward  as  is  necessary. 


37 

Patient  lies  on  face;  after  a  thorough  relaxation, 
place  thumb  of  one  hand  on  angle  of  ribs,  or  between 
angle  and  head,  the  other  hand  beyond  the  angle 
pressing-  upward  or  downward  as  is  necessary, 
then  suddenly  through  pressure  on  head  of  rib 
with  thumb  turn  the  head  into  its  place. 

Patient  may  lie  on  back,  the  physician  places  his 
hand  under  the  patient  with  palms  of  fingers 
under  the  affected  rib.  Draw  arm  across  chest 
and  grasping  elbow  firmly  press  outward  and  down- 
ward. This  relieves  the  rib  from  pressure  and 
allows  it  to  slip  into  place.  A  very  successful 
method  of  raising  a  rib  consists  of  putting  the  knee 
in  back  against  the  angle  of  rib,  reach  around 
opposite  side  to  sternal  articulation.  Have  patient 
draw  full  breath.  Then  draw  the  arm  up  and 
backward,  pressing  the  rib  into  its  position  by  the 
hand  in  front  and  knee  behind. 


38 


Diseases 

Their  Osteopathlc  Causes,  Conditions  and  Treatment 


ACNE. 

THE  Osteopathic  treatment  consists  in  stimu- 
lation to  the  kidneys  and  correction  of  spinal 
lesion  at  eleventh,  twelfth  dorsal  or  first  lumbar 
and  in  the  cervical  region  interfering1  with  the 
action  of  the  vaso-motors.  Also,  correction  of  any 
condition  which  may  affect  the  action  of  the  bowels. 
The  vaso-motors  should  be  stimulated  and  all 
impediments  to  the  circulation  removed.  In  cases 
of  females  it  is  essential  that  all  uterine  disorders 
be  corrected.  Some  cases  are  remarkably  obsti- 
nate. Pay  especial  attention  to  diet. 

Diet.  Milk,  eggs,  cereals,  meat  broths  and 
game.  Avoid  all  pastry,  sweets,  and  greasy  foods. 

PLATE  7. 

Relaxation  of  the  Lumbar  Region.  Patient  as  in  plate. 
The  palmar  surfaces  of  the  fingers  are  placed  on  either  side 
of  the  spines.  The  knuckles  rest  on  the  table.  The  patient 
is  lifted  on  the  flat  portion  of  the  fingers,  the  pressure 
being  upward  and  outward.  This  movement  should  be  re- 
peated several  times  at  each  point.  This  is  an  excellent 
treatment  in  kidney  trouble,  lumbago  and  in  female 
troubles. 


40 
AGUE  (MALARIA,  CHILLS  AND  'FEVER,  INTERMITTENT 

FEVER.) 

In  this  disease  the  Osteopath  considers  a  parasite 
as  the  exciting-  cause  though  the  general  condition 
of  the  patient  makes  the  disease  possible.  Cor- 
rective treatment  is  directed  towards  the  lesion 
usually  found  at  the  seventh  to  eleventh  dorsal 
vertebrae.  To  aid  in  restoring-  the  system  the 
liver  and  spleen  should  be  vibrated  daily  as  these 
g-lands  are  directly  implicated.  The  chill  may  be 
broken  by  strong-  stimulation  of  dorsal  nerves,  third 
to  eleventh.  This  will  usually  produce  a  perspira- 
tion in  three  to  five  minutes.  To  prevent  the 
pyrexia,  strongly  bend  head  backward  holding- 
firmly  the  vertebral  arteries  at  junction  of  atlas 
and  occiput;  this  may  be  alternated  with  steady 
pressure  on  the  inferior  cervical  g-ang-lion  at  head 
of  first  rib.  The  sweating-  may  be  relieved  by 
steady  pressure  in  the  upper  dorsal  reg-ion  and  by 
sponging-  with  tepid  wrater.  The  bowels  must  be 
kept  open. 

D.iet.  Avoid  all  foods  tending-  toward  bilious- 
ness and  constipation. 


ANAEMIA. 

Anaemia  is  not  a  disease  but  a  symptom.  The 
causes  are  various;  so  must  be  the  nature  of  the 
treatment.  The  most  common  causing-  conditions 
are  to  be  found  in  the  lesions  which  produce  consti- 
pation, dig-estive  troubles,  menstrual  disorders  and 


41 

derangement  of  the  circulatory  system.  Common 
chlorosis  will  yield  to  strong-  stimulation  in  the  cir- 
culation centers,  tog-ether  with  corrective  treat- 
ment for  various  lesions  mentioned  above.  A  very 
common  lesion  is  in  the  lumbar  region,  second  and 
third  or  fifth,  causing-  either  constipation  or  uterine 
disorders,  one  or  both.  Thoroug-h  vibration  of  the 
liver  and  spleen,  stimulation  at  the  eig-hth  and  ninth 
dorsal,  tog-ether  with  correction  of  any  lesion  at  this 
place  will  be  of  value.  Frequently  a  depressed 
clavicle  and  drooping-  ribs  are  causes.  Should 
dig-estive  disturbances  accompany  the  condition, 
look  for  displaced  rib  or  vertabra  from  fourth  to 
eig-hth  dorsal.  Outdoor  exercise,  cold  baths,  chang-e 
of  occupation  will  all  be  valuable. 

Diet.    Milk  between  meals  and  especially  at  bed 
time,  eg-g-s  in  all  forms,  rare  meats  and  ice  cream. 

Avoid  pickles,  vineg-ar,  gravies  and  rich  sauces. 


ANGINA   PECTORIS. 

In  true  angina  there  is  a  neurosis  of  the  nerves  to 
the  heart.  In  pseudo  anginas  the  trouble  is  inter- 
costal. Occasionally  it  is  reflected  from  the  stom- 
ach. Examine  carefully  the  thoracic  wall,  second 
to  sixth  rib  and  vertebrae.  In  nearly  all  such  cases 
the  third,  fourth  or  fifth  ribs  on  left  side  will  be 
found  sub-dislocated.  This  dislocation  is  usually  at 
the  vertebral  end.  There  is  marked  tenderness  at 
the  angle  of  the  rib,  at  the  costo-chondral  or  costo- 


42 

sternal  articulations,  and  usually  along-  the  inter- 
costal spaces.  Occasionally  the  first  rib  is  deflected. 
Look  carefully  to  the  fifth  and  sixth  cervical  for 
disturbances  at  the  middle  cervical  gang-lion.  Ante- 
rior or  lateral  curvature  in  upper  dorsal  region  is 
common.  In  cases  of  tachycardia  and  hig-h  blood 
pressure  a  steady  pressure  on  middle  and  inferior 
cervical  g-ang-lion  will  be  effective.  In  cases  of 
bradycardia  the  heart  may  be  aroused  by  thoroug-h 
stimulation  of  these  points.  Friction  over  the 
heart  and  separation  of  the  ribs  will  be  valuable. 
The  use  of  tobacco,  alcohol,  etc.,  must  be  prohibited. 
Quiet  outdoor  life  is  indicated.  The  false  anginas 
may  be  completely  cured.  True  ang-inas  can  be 
relieved,  but  perhaps  never  cured. 

Diet.  Use  concentrated,  nutritious  and  easily 
dig-ested  foods. 

APPENDICITIS. 

The  lesion  in  this  disease  is  to  be  found  in  the 
lower  dorsal  and  lumbar  region.  This  may  be 

PLATE  8. 

Neck  Extension,  "With  one  hand  take  hold  of  the  head 
just  below  the  prominence  of  the  occiput,  the  thumb  extend- 
ing' to  the  mastoid  process  of  one  side,  the  fingers  reaching 
to  the  corresponding  point  on  the  opposite  side.  The  other 
hand  clasps  the  chin.  Steady  traction  is  then  made,  the 
neck  being-  kept  straight  or  nearly  so.  A  slight  oscillation 
will  sometimes  be  useful  in  relaxing  the  structures.  Care 
must  be  taken  not  to  rotate  the  neck  while  traction  is  being 
made.  By  throwing  the  head  forward  the  ligamentum 
nuchae  and  the  ligamenta  subflavamay  be  stretched,  reliev- 
ing tension  on  the  nerves  of  the  cervical  and  brachial  plex- 
uses and  relaxing  muscular  contractions  in  cervical  region 
generally. 


44 

either  primary  or  it  may  be  merely  contraction,  the 
result  of  constipation,  impaction,  etc.  This  disease 
may  be  a  sequella  to  various  acute  diseases. 
The  treatment  should  be  directed  towards  correct- 
ing- the  slip  in  the  vertebrae  and  this  will  in  most 
cases  be  effective.  Examine  the  eleventh  and 
twelfth  ribs  carefully.  Gentle  manipulation  over 
the  right  iliac  fossa,  quiet  manipulation  of  the  limb 
with  external  rotation  is  of  some  value.  Constipa- 
tion and  impaction  must  be  overcome  by  the  enema. 
Osteopathy  has  been  marvellously  successful  in 
this  disease.  Hot  applications  will  be  of  value  in 
removing-  cong-estion  and  pain.  Treatment  should 
be  administered  several  times  daily  in  order  to 
keep  the  pain  and  inflammation  under  control. 
Avoid  cases  in  the  late  stag-es. 

Diet.     Milk  and  buttermilk,  beaten  eg-g-s,  nutri- 
tive broth.     Avoid  foods  with  residue. 


APOPLEXY. 

In  addition  to  the  usual  precautions  in  nursing-, 
bathing,  die't,  etc.,  the  Osteopath  \vould  proceed  as 
follows:  First  thoroughly  relax  the  cong-ested  and 
contracted  muscles  of  the  cervical  region;  this  will 
reduce  pressure  by  facilitating-  drainage  and  by 
decreasing  vaso-constrictor  action.  The  circula- 
tion may  be  further  equalized  by  thorough  quiet- 
ing manipulation  of  the  muscles  of  the  back  on 
either  side  of  the  spine.  Dislocated  atlas  and  axis 


45 

are  apt  to  be  causes  of  these  conditions.  Reduc- 
tion of  these  dislocations  will  give  relief  in  some 
cases.  Clavicle  and  first  rib  are  important  struc- 
tures. 

Manipulation  of  affected  nerves  and  muscles  will 
be  valuable  in  maintaining-  vitality  of  tissue.  Keep 
bowels  open  and  kidneys  active.  Ice  bag's  at  head 
and  neck,  and  heat  at  feet  are  advised. 

Diet.  All  nourishing- foods  in  liquid  form.  Soft 
cooked  eg-g-s,  beef  broth,  etc. 

Avoid  alcoholic  stimulants. 


ARTHRITIS. 

The  cause  is  often  remote.  Examine  carefully 
for  evidences  of  uterine  trouble  in  female.  The 
disease  seems  to  be  a  referred  effect  upon  the  cen- 
tral nervous  system  of  peripheral  irritation. 
There  are  usually  spinal  lesions  which  correspond 
with  joints  affected.  The  treatment  consists  in 
correcting-  these  lesions,  manipulating-  the  nerves 
to  the  joints  and  in  thoroug-h  massag-e  of  surround- 
ing- structures  to  induce  lymphatic  absorption  and 
to  facilitate  drainag-e.  The  depurative  org-ans  must 
be  kept  active  and  the  circulation  maintained  at  its 
normal.  The  affected  joints  must  be  extended 
and  flexed  several  times  at  each  treatment.  Bath- 
ing- is  a  valuable  adjunct  to  our  treatment.  If 
taken  in  early  stages  a  cure  is  the  rule.  Later,  the 
prognosis  is  not  so  favorable.  There  is  no  particu- 


46 

lar  virtue  in  a  short  course  of  treatment,  and  you 
should  make  it  thoroughly  understood  that  months 
and  even  years  may  be  required  to  effect  a  cure. 
Diet  and  exercises  are  valuable. 

Diet.     Good  roast  beef,  beefsteak,  mutton,  fo\\l, 
fish,  eggs  and  milk.     Avoid  low  diet. 


ASCITES. 

The  lesions  in  this  condition  must  vary  with 
the  cause.  The  condition  may  result  with  dis- 
turbed heart  action,  valvular  incompetency,  hepatic 
and  renal  affections.  Careful  examination  of  these 
organs  must  be  made  to  determine  the  location  of 
the  lesion.  'Vertebral  or  costal  slip  from  seventh 
to  tenth  may  be  a  cause  of  hepatic  obstruction.  The 
lesion  will  be  eleventh  to  twelfth  dorsal  if  from 
renal  disturbance,  and  from  third  to  sixth  dorsal 
if  due  to  cardiac  incompetency.  Stimulate  the 

PLATE  9. 

Springing  Spine  Forward.  Figure  of  Eight  Movement. 
Diarrhoea  treatment  The  fingers  of  one  hand  are  placed 
at  the  upper  lumbar  vertebra,  the  spinous  process  between 
the  third  and  fourth  fingers.  The  other  arm  reaches  be- 
neath the  legs  at  the  knees.  The  legs  are  now  strongly  ele- 
vated while  pressure  is  applied  with  the  other  hand.  Hold 
for  about  fifteen  seconds.  This  may  be  repeated  for  the 
three  or  four  upper  lumbar.  To  increase  the  efficacy  of  this 
treatment  the  patient's  legs  should  be  moved  so  as  to  describe 
a  figure-of-eight  movement;  draw  them  toward  you,  then  up- 
ward, and  down  as  they  are  swung  back  to  the  table.  The 
movement  is  continued  through  the  opposite  side.  Two  or 
three  movements  of  this  kind  will  be  sufficient.  Steady 
pressure  should  be  applied  to  the  lower  dorsal  and  lumbar 
regions  after  these  movements.  These  movements  will  cure 
flux,  diarrhoea,  dysentery,  etc. 


48 

heart  action,  increase  the  drainage.  A  g-eneral 
treatment  in  addition  to  the  specific  treatment  is 
indicated.  Treat  daily  until  the  excess  of  fluid 
is  overcome.  Cases  taken  early  yield  readily; 
advanced  cases  are  more  obstinate,  and  in  many 
instances  cannot  be  controlled.  The  diet  is  an 
important  part  of  the  treatment,  and  must  be 
varied  according-  to  the  organs  affected. 

Diet.  Must  be  dry  diet,  consisting-  of  bread  and 
meat  chiefly.  Some  advise  a  liquid  diet;  we  do  not 
think  this  wise  except  where  urine  is  very  scant. 


ASTHMA. 

The  lesion  in  this  disease  is  usually  to  be  found 
in  the  region  of  the  third  to  seventh  rib.  The  con- 
dition is  usually  caused  by  one  or  more  of  these 
ribs  being-  thrown  downward.  This  lesion  may 
occur  on  either  side.  There  is  usually  tenderness 
on  pressure  at  the  ang-les  of  the  ribs  and  at  their 
costo-transverse  articulation.  Tenderness  is  some- 
times manifest  at  the  head  of  the  first  rib. 

Raise  the  ribs  by  any  of  the  methods  given. 
(See  plates  13,  17  and  32.)  Strong-  inhibition  at  the 
inferior  cervical  g-angiion  is  palliative.  In  some 
cases  pressure  at  the  head  of  the  first  rib  will 
relieve  the  most  violent  paroxysms.  Treat  twice 
a  week;  it  is  rarely  necessary  to  treat  oftener. 
Stop  treatment  when  lesion  is  reduced. 

Prognosis,  Is  g-ood.  Almost  all  uncomplicated 
cases  yield  in  one  or  two  months. 


49 

ATAXIA,  LOCOMOTOR.    (TABES  DORSALIS.) 

In  this  disease  there  is  always  a  spinal  lesion, 
althoug-h  it  is  impossible  to  say  where  it  will  be 
found  in  a  given  case.  Usually  the  trouble  is  in 
the  lumbar  and  lower  dorsal  regions.  In  some 
cases  there  are  lesions  of  ribs  implicating-  the  inter- 
costal nerves.  Thoroughly  relax  the  spine  with 
extension,  reduce  the  dislocations,  separate  the 
ribs.  Control  the  gastric  crises  in  the  dorsal 
region  by  correction  and  by  steady  pressure.  The 
exacerbation  of  pain  may  be  overcome  by  inhibition 
in  the  lumbar  region.  Give  strong-  external  rota- 
tion and  steady  pressure  on  the  sciatic  nerve  about 
midway  between  the  great  trochanter  and  the 
tuberosity  ischii.  Require  patient  to  gradually 
leave  off  the  use  of  morphine,  as  little  or  nothing- 
can  be  done  while  the  patient  is  using-  opiates. 
Applications  of  heat  may  be  useful. 

Prognosis.  Nearly  all  cases  may  be  alleviated — 
most  of  them  permanently  benefited — a  few 
cured.  Long-  and  persistent  treatment  is  neces- 
sary. 

Do  not  promise  a  cure,  as  it  is  impossible  to 
foretell  the  result  even  where  there  is  a  definite 
lesion.  It  may  be  secondary  or  incidental. 

Diet.  A  g-enerous  diet  may  be  prescribed,  such 
as  butter,  gravies,  cream,  cod  liver  oil,  etc.  Avoid 
liquors,  tobacco,  etc.,  to  excess. 


50 

ATROPHY,  PROGRESSIVE  MUSCULAR. 

In  this  disease,  whose  cause  is  unknown  to  the 
medical  world,  the  Osteopath  has  had  but  slight 
experience.  The  condition  would  indicate  trouble 
in  the  upper  dorsal  and  cervical  regions.  The 
trophic  nerves  to  the  muscles  of  the  arm  seem  to 
be  associated  with  the  brachial  plexus  and  may  be 
affected  either  through  it  or  through  its  vaso-motor 
control  in  the  upper  dorsal  region.  Attention  to 
the  cervical  ganglion  is  indicated.  Look  for  involve- 
ment of  the  vertebral  arteries.  Thorough  relaxa- 
tion and  extension  of  the  cervical  and  dorsal  spines 
will  be  helpful.  Or  the  lesion  may  be  found  in  the 
lower  dorsal  and  lumbar  region.  Bathing  and  exer- 
cise in  moderation  are  valuable. 

Prognosis.  Is  bad.  All  that  may  be  expected 
in  advanced  cases  is  to  stay  the  progress  of  the 
disease. 

Diet.     Any  nourishing  foods. 

PLATE  10. 

To  Correct  a  Posterior  Lower  Dorsal  or  Upper  Lumbar 
Vertebra.  After  a  thorough  relaxation  patient  is  placed  on 
side.  The  legs  and  thighs  are  as  shown  in  cut.  One  hand 
is  placed  on  the  posterior  vertebra,  the  other  clasping  the 
legs.  By  means  of  the  body  weight  the  thighs  are  pushed 
up  against  the  abdomen  thus  exaggerating  the  condition. 
The  hand  now  presses  strongly  against  the  vertebra  and  the 
legs  are  suddenly  straightened.  The  sudden  release  and 
pressure  forward  on  the  vertebra  will  throw  it  back  into  its 
position.  By  reaching  over  as  in  plate  and  pulling  upon 
spine,  the  knees  being  held  against  the  body,  the  deep  con- 
tractures  in  this  region  may  be  overcome. 


52 

BOILS. 

Look  to  the  emunctory  organs.  As  a  preventa- 
tive  the  skin  must  be  thoroughly  cleansed  daily. 
Friction  with  a  turkish  towel  will  aid  in  obtaining 
this  result.  Where  the  boils  are  confined  to  cer- 
tain regions  the  indications  point  to  a  local  lesion 
interfering-  with  the  drainage.  If  the  head  and 
neck  are  affected  the  trouble  is  in  the  cervical 
region.  If  the  lower  limbs  are  affected  look  for  the 
trouble  in  the  lumbar  and  sacral  regions.  In  all 
cases  stimulate  the  lymphatics  by  manipulations. 
Look  for  circulatory  disturbances;  the  liver  and 
spleen  are  frequent  causes  of  this  condition.  The 
sexual  organs  may  be  at  fault.  Sexual  perversion 
or  irregularity  may  cause  it. 

Diet.  Cereals,  fruits,  lean  meats,  broths,  light 
vegetables  and  buttermilk.  Avoid  butter,  gravies 
and  all  greasy  foods,  rich  milk,  sugars,  etc. 


BRAIN    TROUBLES. 

The  Osteopath's  work  is  directed  toward  two 
primary  objects: 

First.  The  equalizing  of  the  general  circulation 
of  the  blood. 

Second.  The  continued  control  of  the  blood 
supply  to  the  brain  and  the  correlative  drainage. 

To  accomplish  these  ends  the  circulatory  centers 
are  first  thoroughly  treated;  the  muscles,  ligaments 
and  tissues  which  surround  them  are  relaxed  bv 


53 

pressure  and  by  movements  which  will  stretch  the 
tissues.  The  next  treatment  is  a  stimulation  put 
upon  the  deeper  structures  so  as  to  secure  the 
action  of  the  heart  and  arteries.  The  third  to  fifth 
dorsal  is  the  region  for  this  work.  Next,  raise  the 
clavicles;  notice  carefully  the  first  rib  and  put 
steady  pressure  on  the  inferior  cervical  ganglion. 
The  solar  plexus,  controlling  the  lumen  of  the  mes- 
enteric  vessels,  aid  in  controlling  blood  pressure. 
The  hand  laid  firmly  over  the  solar  plexus  will 
reduce  general  arterial  pressure  and  by  equalizing 
the  flow  will  relieve  congestion  in  any  part  of  the 
body.  The  tissues  of  the  neck  demand  a  complete 
relaxation.  This  is  for  drainage.  Then  by  hold- 
ing the  vertebral  arteries  for  three  to  five  minutes, 
the  head  thrown  backward,  the  cerebral  congestion 
is  overcome.  In  cases  of  cerebral  congestion  the 
feet  should  be  placed  in  warm  water  and  ice  bags 
applied  at  basis  crani. 

Diet.     A  frequent  change  of  diet  is  advisable. 
Foods  should  be  light,  nourishing  and  laxative. 


BRIGHT 'S    DISEASE. 

Spinal  lesion  is  from  tenth  dorsal  to  second  lum- 
bar. This  must  be  corrected.  There  is  always 
contraction  of  muscles  and  tightning  of  ligaments 
in  this  region,  though  there  may  be  no  osseous 
lesions.  The  patient  lies  first  on  face,  and  steady 
pressure  upward  and  outward  of  the  muscles  of  the 


54 

dorse-lumbar  region  will  give  a  thorough  relaxation. 
Oscillating- lower  part  of  spine  has  the  desired  result. 
Patient  lies  flat  on  face.  Place  one  hand  firmly  on 
spine  at  point  desired  and  apply  steady  pressure; 
with  other  hand  oscillate  the  limbs  from  side  to 
side.  Place  patient  on  back,  leg's  and  thighs 
flexed,  leaning-  over  patient  place  fingers  under  the 
spines  and  lift  him  on  fing-er  tips;  or  give  the  same 
treatment,  the  patient  lying  completely  extended 
and  thoroughly  relaxed.  The  patient's  weight  is 
thus  an  aid  to  the  end  sought.  Stretching  the 
spine  in  the  swing  is  indicated.  The  warm  pack, 
sweating  and  alkaline  waters  are  adjuvants. 
Several  months'  treatment  will  be  necessary  in 
pronounced  cases. 

Diet.  In  no  disease  is  the  diet  of  more  impor- 
tance than  in  this. 

Skimmed  milk  is  the  all-important  food  in  many 
cases;  if  patient  is  an  invalid,  seven  or  eight  pints  a 
day  will  be  sufficient;  if  patient  exercises  a  good  deal 

PLATE  11. 

To  Correct  a  Lateral  Vertebra  in  the  Dorsal  Region.  After 
a  thorough  relaxation  and  spinal  extension,  patient  ia  seated 
as  in  plate.  The  hands  are  placed  on  either  side  of  the 
vertebra  which  is  misplaced.  The  patient  is  held  on  stool 
with  the  knee.  The  physician  lifts  up  and  at  the  same 
time  bends  the  spine  in  the  direction  opposite  to  the  curva- 
ture. This  exaggerates  the  condition  and  loosens  all  con- 
nective tissue  bindings.  The  body  is  then  thrown  to  the 
opposite  side  and  pressure  is  brought  to  bear  on  the  verte- 
bra, forcing  it  into  position.  By  suspending  the  patient 
from  the  shoulders  in  "the  swing"  the  treatment  may  "be 
given  very  effectively. 


PLATE  11. 


56 

add  cereals,  nuts,  rice  and  stale  bread  to  his  milk 
diet. 

Avoid  meats,  alcohol,  tobacco,  etc. 


BRONCHITIS. 

In  either  acute  or  chronic  bronchitis  the  treat- 
ment is  directed  to  the  vaso-motors  of  the  bronchial 
tubes  as  well  as  to  the  motor  filaments.  The  best 
results  are  obtained  by  stimulation  at  the  second, 
third  and  fourth  Vibs.  The  patient  is  placed  on 
stool  and  these  ribs  are  elevated  by  pressing-  thumb 
against  the  head  of  the  rib  and  throwing-  the  arm 
upward  and  slig-htly  backward.  Use  care  to  avoid 
dislocating-  shoulder.  Patient  is  placed  on  side  and 
ribs  are  separated  by  holding- rib  with  one  hand  and 
lifting-  rib  next  above  with  other  hand.  This  is  done 
with  the  first  four  ribs  consecutively.  The  patient 
is  next  placed  on  back  and  the  costal  cartilag-es  are 
separated  by  placing-  the  fing-ers  between  them, 
then  turning-  fingers  and  spreading-  hands  at  the 
same  time.  At  close  of  treatment  put  your  knee  in 
upper  dorsal  and  bring-  arms  up  and  back,  the 
patient  taking  deep  inhalation,  then  exhaling  as 
the  arms  are  released.  Acute  cases  should  be 
treated  daily  or  oftener. 

Prognosis.     Good. 


BRADYCAKDIA. 

For  this  symptom  the  cause  must  be  found.     In 
most  cases  the  trouble  is  in  the  sympathetic  fibers 


57 

of  middle  and  inferior  cervical  gang-lion.  The  lesion 
is  usually  in  the  upper  dorsal.  Rarely  it  is  a  reflex 
from  peripheral  disturbance  to  the  pneumo-gastric 
(tenth  cranial)  nerve.  Stretching-  the  spine,  rais- 
ing- the  clavicles  and  correcting  the  upper  ribs 
will  usually  correct  the  difficulty.  There  is 
marked  tenderness  at  the  spines  of  the  second  to 
fifth  vertebrae,  with  contractures  and  tenderness 
between  the  ribs  at  their  vertebral  portion.  There 
is  usually  a  corresponding  tenderness  between  the 
ribs  anteriorally;  in  many  cases  it  is  most  pro- 
nounced at  the  sternal — or  costo-chohdral  articula- 
tion. I  have  found  a  strong  dilation  of  the  sphincter 
ani  very  effective  in  securing  a  permanent  cure. 
Prognosis.  Recovery  is  the  rule. 


BLADDER    TROUBLE CYSTITIS. 

The  lesion  may  be  peripheral  through  irritation 
from  preputial  adhesions,  etc.,  or  from  morbific 
substances  in  the  bladder  itself.  In  case  of  much 
pus  it  is  best  to  thoroughly  wash  the  bladder  with 
movements.  Then  correct  the  osseous  lesions, 
potassium  bichromate  or  hydrogen  peroxide..  The 
second,  third  andfourth  sacral  nerves  will  be  found 
involved.  Often  the  twelfth  dorsal  and  first  lumbar 
are  at  fault.  Sometimes  the  trouble  is  at  the  second 
and  the  third  lumbar.  Always  relax  thoroughly  in 
these  regions  by  steady  pressure  and  by  stretching 
Thorough  relaxation  in  the  ischio-rectal  fossa 


58 

works  through  the  perineal  branches  of  the  pudic 
nerve  and  thus  allays  the  irritation  of  the  bladder. 
The  rectum  should  be  examined,  as  it  may  reflexly 
affect  the  bladder.  The  prostate  gland  is  often 
involved. 

Prognosis.     Favorable. 


BILIARY    CALCULI —  (GALL    STONES.) 

The  liver  is  usually  enlarged  and  shows  marked 
tenderness  on  palpation.  The  characteristic  lesion 
is  usually  to  be  found  at  the  eighth  to  tenth  dorsal, 
or  at  the  corresponding  ribs.  In  case  of  parox- 
ysms relief  is  obtained  on  pressing  inward  at 
a  point  two  inches  above  and  the  same  distance 
to  the  right  of  the  umbilicus.  Thorough  manip- 
ulation of  this  entire  region,  together  with  a 
downward  movement  in  the  line  of  the  bile  duct, 
will  aid  in  expelling  the  calculus  from  the  duct. 
A  strong  stimulation  at  the  margin  of  the  cartilages 
of  the  ninth  and  tenth  ribs  will  produce  peristalsis 

PLATK  12. 

Correcting  an  Anterior  Dorsal  Vertebra.  The  patient 
sits  on  stool,  the  physician  standing  behind  him  with  the 
knee  firmly  pressed  against  the  vertebra  next  below  the  one 
which  is  dislocated.  The  physician  places  his  hands  on 
the  ribs  corresponding  to  the  vertebra  which  is  dislocated 
and  by  pulling  backward  the  vertebra  can  be  slipped  into 
its  place.  Patient  should  hold  the  lungs  full  of  air  till  the 
force  has  been  applied.  The  same  result  may  be  accom- 
plished by  having  the  patient  lie  on  back  and  bend  the  body 
up  onto  the  dorsal  spine,  then  throw  the  weight  on  the 
spinal  column,  holding  the  vertebra  above  the  anterior  one 
as  the  point  of  support.  This  is  a  very  effective  movement, 
but  should  be  administered  with  care. 


PLATE  12. 


60 

of  the  cyst  and  ducts  and  aid  in  relieving-  this  con- 
dition. The  ribs  should  be  elevated  and  separated. 
Any  osseous  lesions  at  the  eighth  to  tenth  dorsal 
must  be  corrected.  A  general  stimulation  to  the 
heart  and  lung's  is  indicated  so  as  to  increase  oxida- 
tion processes. 

Prognosis.     Relief  is  almost  certain.     A  cure  is 
the  rule. 


CALCULUS, — RENAL. 

The  treatment  is  directed  to  the  liver  and  the 
kidney  regions  in  the  spine.  Gentle  manipulation 
downward  over  the  line  of  the  ureter  is  indicated 
during-  the  passage  of  a  stone.  Relief  may  also  be 
obtained  by  steady  pressure  at  tenth  dorsal  to  first 
lumbar.  Gentle  manipulation  of  the  abdomen  over 
each  kidney  is  useful.  Thorough  relaxation  of  the 
quadratus  lumborum  eases  the  condition.  In  case 
the  urine  shows  uric  acid,  alkaline  waters  are 
indicated.  If  oxalate  of  lime,  then  thorough  gen- 
eral treatment  must  be  given  to  increase  oxidation. 
The  patient  must  take  plenty  of  outdoor  exercise. 
The  respiratory  activity  must  be  increased  by 
placing  the  knee  in  back  and  drawing  the  arms 
upward,  or  by  any  other  method.  The  hot  bath 
frequently  gives  relief. 

Prognosis.     Treatment  usually  effects  a  cure. 

Diet.  Meats,  if  urine  shows  phosphates;  milk 
and  vegetables,  if  it  has  uric  acid  deposit.  In  either 


61 

condition  patient  must  drink  not  less  than  four 
pints  of  water  daily. 


CARDIAC    TROUBLKS. 

In  case  there  are  irregularities  or  incompetency 
much  may  be  done  toward  correcting- the  condition, 
but  a  cure  is  impossible  in  organic  lesions  after 
puberty. 

Lesions.  At  cervical  vertebrae,  fifth  to  seventh; 
at  head  of  first  rib;  at  fifth  dorsal  and  fifth  rib  on 
left  side;  tenderness  at  costo-chondral  articulation 
of  fifth  rib,  sometimes  fourth  to  sixth. 

Treatment.  Relax  the  muscles  in  regions  named; 
correct  any  osseous  lesions.  Raise  the  ribs  and 
separate  those  on  left  side.  Set  fifth  dorsal  and 
fifth  rib.  Raise  the  clavicle.  A  cure  is  rare; 
marked  improvement  is  the  rule. 

Diet.  Give  nourishing  food,  all  dig-estible  meats, 
etc.  Avoid  soups  and  liquid  diet,  coffee,  tea  and 
all  alcoholic  drinks. 


CATARACT. 

In  this  condition  there  is  usually  reflex  or  a  pri- 
mary disturbance  at  the  atlas  or  the  cilio-spinal 
center  in  the  upper  dorsal  region.  In  1  per  cent 
there  is  diabetic  condition;  in  6  per  cent  urine 
shows  albumen.  This  shows  that  the  quality  of 
the  blood  and  the  condition  of  the  nervous  system 
are  strong  conditions  favoring  the  disease.  Absorb- 


62 

tion  by  thorough  drainage  is  the  only  Osteopathic 
indication.  Correct  any  lesion  in  cervical  and 
upper  dorsal  regions.  Treat  the  superior  cervical 
gang-lion  very  lightly,  not  oftener  than  two  or  three 
times  a  week.  The  eye  should  be  vibrated  daily 
by  laying- the  fing-ers  of  one  hand  on  the  closed  lids, 
and  rapidly,  yet  lig-htly,  striking-  it  with  the  other. 
By  moving-  the  eye  from  side  to  side  with  thumb 
and  fing-er  the  lymphatics  are  stimulated.  The 
g-eneral  health  of  the  patient  must  be  carefully 
attended  to  by  out-door  exercise.  See  that  patient 
is  correctly  fitted  with  glasses. 

Prognosis.  In  many  cases  success  has  attended 
Osteopathic  treatment.  Unless  there  is  decided 
improvement  after  two  or  three  months'  treat- 
ment a  surgical  operation  should  be  recommended. 

Diet.  Must  be  nutritious  in  order  to  build  up 
entire  system. 


CATARRH — CORYZA RHINITIS. 

Lesion.     Usually  in  upper  cervical  region. 
As  an  adjuvant,  daily  morning  sponge-baths  in 
cool  or  cold  water,  followed  by  a  brisk  rub  down 

PLATE  13. 

Setting  a  Dislocated  Rib.  This  movement  is  eff active  when 
ribs  are  turned  downward.  Patient  is  seated  on  stool.  The 
physician  stands  as  in  cut,  one  knee  being-  placed  beneath 
the  head  and  angle  of  the  rib  that  is  displaced.  The  rib  is 
held  anteriorly  as  in  cut.  The  patient  takes  deep  breath 
holding  it  while  the  physician  elevates  the  arm  as  shown. 
The  rib  is  turned  upward  with  the  hand,  the  knee  pressing 
firmly  against  the  angle.  The  arm  is  now  thrown  back- 
ward, downward  and  forward  to  its  natural  position. 


Pi  ATE   13. 


64 

should  be  recommended.  Daily  exercise  in  breath- 
ing- deepest  possible  inhalation  and  holding-  the 
breath  as  long  as  possible,  followed  by  forcible 
exhalation,  is  a  great  feature  in  securing  proper 
circulation  and  oxidation.  Do  not  allow  mouth- 
breathing;  close  mouth  by  chin  support  at  night. 
Treat  by  relaxing  the  muscles  in  upper  cervical. 
Treat  superior  cervical  ganglion  at  the  second  and 
third  cervical.  Strongly  inhibit  at  supra-orbital, 
infre-orbital  and  mental  foramina.  Strongly  press 
on  nose  at  inner  cauthus.  Bring  the  thumbs  down 
on  either  side  of  nose  briskly  several  times.  Dip- 
ping- the  finger  in  cold  water,  reach  back  through 
mouth  to  posterion  nares  and  gently  move  the  tis- 
sue from  side  to  side.  Put  fingers  just  behind 
angle  of  inferior  maxillary,  and  while  pressing 
g-ently  have  patient  open  and  close  mouth;  repeat 
several  times. 

Prognosis.     Favorable. 


CHIC  KEN  POX. 

This  disease  rarely  requires  the  aid  of  a  phy- 
sician. Isolation  until  desquamation  is  completed  is 
necessary.  Daily  sponge  baths  and  airy  rooms  will 
aid.  In  case  of  temperature,  reduce  it  by  holding 
the  sub-occipital  region  or  by  pressure  on  the 
inferior  cervical  ganglion.  A  general  treatment 
will  relieve  any  unpleasant  feeling.  Vaselin  or 
oil  will  allay  the  itching. 

Progonosis.     Good. 


65 

CHOLERA    INFANTUM. 

The  Osteopathic  treatment  consists  in  steady 
pressure  on  abdomen  over  solar  and  inferior  mes- 
enteric  plexuses.  A  very  g-entle  manipulation  of 
abdomen  is  g-ood.  Steady  pressure  over  splanchnics 
and  spinal  nerves,  from  the  dorsal  to  the  coccyx, 
will  usually  give  relief;  the  thumbs  pressed  on 
either  side  of  spine  in  lumbar  region,  with  patient 
lying-  on  his  face,  is  the  most  effective  treatment. 
The  spine  should  be  sprung-  forward  by  bending- 
leg's  upward  and  backward,  pressing-  in  lumbar 
region.  Treatments  must  be  given  several  times 
daily.  Enemas,  as  hot  as  the  elbow  may  comfort- 
ably endure,  may  be  given.  This  should  be  of 
castile  soap  suds  and  not  less  than  two  pints  so  as 
to  thoroug-hly  wash  the  colon.  This  may  be  fol- 
lowed by  an  injection  of  cooler  water  with  tannic 
acid,  twenty  grains  to  the  pint,  to  precipitate  the 
poisonous  proteids. 

Prognosis.     If  taken  early,  g-ood — later,  doubtful. 

Diet.  No  milk  must  be  given  until  all  symptoms 
have  abated.  No  food  for  twenty-four  to  thirty-six 
hours.  A  spoonful  of  champag-ne  or  a  little  whisky 
and  water  will  prevent  collapse.  Baths  in  warm 
mustard  water  with  friction  also  aids  in  preventing- 
collapse.  After  twenty-four  hours  give  barley 
water;  next,  meat-juice  broths  and  eg-g-  albumen. 


66 

CHOLERA  MORBUS. 

To  stop  the  nausea  and  vomiting-,  pressure  is 
applied  at  fourth  and  fifth  rib  on  right  side,  at 
same  time  separate  the  ribs  by  elevating-  the  right 
arm.  Treat  by  steady  pressure  on  the  splanchnic 
and  lumbar  nerves.  An  enema  of  hot  soapsuds  is 
indicated.  Keep  the  patient  quiet.  Little  water 
should  be  allowed.  Thirst  may  be  relieved  by  iced 
tea  without  sug-ar,  or  by  cracked  ice.  Treatments 
may  be  rather  severe  in  case  of  adults.  Nothing- 
should  be  eaten  while  symptoms  are  pronounced. 

Prognosis.     Good. 

Diet.  Meat  broths,  milk  and  lime-water  in 
small  quantities  until  convalescent,  then  restore 
usual  diet  very  gradually. 


CHOREA — ST.  VITUS'  DANCE. 

Lesions.  When  affecting-  the  face  and  arms  only, 
the  lesion  is  found  in  the  cervical  vertebrae  or  in 
the  upper  dorsal  region,  either  the  rib  or  the  verte- 
brae. When  only  a  set  of  muscles  are  involved  the 
lesion  is  in  the  spinal  region,  which  marks  the 
emerg-ence  of  the  nerves  to  the  muscles  involved. 

PLATE  14. 

Raising  the  Clavicle.  Patient  as  in  figure.  The  arm  at 
his  side.  Place  your  thumb  beneath  the  clavicle  about  the 
middle  point.  Now  bring- arm  upward  as  in  plate,  continuing 
it  upward,  backward  and  downward.  This  motion  should 
be  made  very  slowly  and  may  be  repeated  two  or  three 
times  at  every  treatment. 


68 

Thorough  spinal  treatment,  including-  thoroug-h 
extension,  tog-ether  with  correction  of  the  lesion 
will  produce  a  cure.  In  cases  of  long-  standing- 
there  may  be  no  marked  tenderness  at  the  seat  of 
the  lesion. 

Uterine  trouble  in  females,  constipation  and 
flatulency  are  conditions  to  be  suspected  and  cor- 
rected if  present. 

Stimulating-  baths  and  outdoor  exercise  are 
beneficial. 

Prognosis,     About  50  per  cent  are  cured. 

Diet.     A  nourishing-  diet  should  be  prescribed. 


CIRRHOSIS    OF    LIVER. 

Look  for  lesion  in  the  splanchnic  region,  usually 
at  or  near  the  eighth  to  tenth  dorsal.  Stimulation 
of  these  nerves  with  correction  of  the  vertebral 
lesions  will  be  effective.  Raise  the  ribs  from  sixth 
to  tenth.  Often  there  is  contracture  of  the  inter- 
costal muscles  which  irritate  the  nerves  from  this 
segment  of  the  cord.  Examine  the  nerves  of  the 
diaphragm  and  the  ribs  to  which  the  diaphragm  is 
attached,  as  this  muscular  partition  may  be  at  fault 
by  preventing  drainage.  The  spleen  is  often 
involved  and  much  enlarged.  The  patient  should 
lie  on  his  back  with  legs  flexed.  The  liver  should 
be  thoroughly  kneaded.  The  patient  may  take  a 
deep  inspiration,  and  as  the  breath  is  released  the 
operator  presses  upward  under  the  seventh  to 


69 

tenth  costal  cartilages.  The  use  of  alcohol  must 
be  interdicted.  If  accompanied  by  inanition,  dys- 
pepsia and  malnutrition  the  stomach  and  intestines 
must  be  carefully  manipulated.  Give  careful  atten- 
tion to  the  heart  centers  (first  and  fifth  ribs).  If 
ascites  is  present  give  a  thorough  stimulation  of 
the  kidneys,  anteriorly  and  a  relaxation  and  inhibi- 
tion over  kidney  center,  eleventh  dorsal  to  first 
lumbar;  avoid  liquid  diet  when  ascites  is  present. 

Prognosis,     Doubtful. 

Diet.     Milk  with  toast  and  crackers;  hot  water 
in  larg-e  quantities. 

Avoid  fats,  sweets  and  fried  foods. 


COLD — CORYZA. 

Thorough  relaxation  of  all  the  tissues  of  the 
neck  and  stimulation  of  cardiac  centers  are  indi- 
cated. Thoroug-h  stimulation  of  the  dorsal  region 
will  close  the  mesenteric  capillaries  and  throw 
blood  to  the  surface.  Stimulation  of  the  fifth 
nerve  at  all  its  exits  is  well.  Put  patient  to  bed; 
give  hot  foot  bath  and  hot  lemonade.  Induce  per- 
spiration. Use  caution  that  there  is  no  exposure 
following-  sweating-. 

Prognosis.     Good. 


CONSTIPATION. 

Lesion.     Lesion  in  lumbar  region,  usually  twelfth 
dorsal  to  third  lumbar.     Sometimes  due  to  dislo- 


70 

cated  coccyx.  In  females  retro-flexion  or  retro- 
version  may  be  the  cause.  Occasionally  a  lesion  in 
the  liver  reg-ion,  sixth  to  tenth  dorsal,  produces 
this  condition.  Atomy  of  the  bowel,  impaction  and, 
in  rare  cases,  imagination  of  the  intestines  are 
causes. 

Treatment.  Correct  the  vertebral  lesions.  In 
all  cases,  except  strangulation,  the  liver  must  be 
treated  both  directly  and  in  its  splanchnic  nerve 
supply.  The  bowels  must  be  kneaded,  following- 
the  line  of  the  colon.  Usually  beg-in  at  the  left 
iliac  reg-ion  over  sig-moid,  kneading-  with  a  down- 
ward motion,  yet  moving-  each  time  to  a  hig-her  por- 
tion of  the  intestines.  In  this  way  the  entire  large 
intestines  should  be  treated.  The  coccyx  must  be 
set  if  dislocated,  and  the  sphincter  dilated  with  a 
retcal  dilator,  as  it  is  more  effective  than  the 
fing-ers.  Never  use  oftener  than  twice  a  week. 

PLATE    15. 

Patient  on  side  as  shown.  Place  one  hand  on  the  iliac 
crest  and  the  other  on  the  scapula  near  the  inferior  angle 
and  on  the  iliac  border.  Draw  the  ilium  forcibly  forward, 
at  the  same  time  rotating-  the  upper  part  of  the  trunk  back- 
ward by  pressure  on  the  scapula. 

This  elevates  the  ribs,  elongates  the  quadratus  lumborum 
muscle  and  removes  pressure  in  the  lower  pelvic  region. 
Now  the  motions  should  be  reversed— the  shoulder  coming 
forward,  the  iliac  thrown  backward.  This  treatment  is 
invaluable  in  all  cases  involving  slips  in  the  lumbar  or 
lower  dorsal  region?.  Lumbago,  crick  in  the  back,  kidney 
roubles  are  either  cured  or  helped  by  this  treatment. 


72 

Outdoor  exercise  will  be  helpful,  as  will  light 
gymnastics. 

In  complicated  cases  I  have  found  most  satisfac- 
tory results  from  liver  vibrations  and  from  knead- 
ing1 the  abdomen.  Urge  regular  hours  for  stool- 
ing-. 

Prognosis.  Good.  Treatment  is  usually  effect- 
ive in  from  four  to  ten  weeks. 

Diet.  The  diet  is  an  important  adjunct.  Fruits, 
cereals  and  plenty  of  water  are  indicated.  Little 
meats  but  an  abundance  of  oils  and  fats.  A  g-lass 
of  cold  water  before  breakfast  and  a  pint  of  hot 
water  on  retiring  will  give  good  results. 


CONSUMPTION  (PULMONARY    PHTHISIS    TUBERCULOSIS 
OF  LUNGS). 

Always  include  a  sputum  test  in  your  examina- 
tion of  pulmonary  troubles. 

Lesions  in  addition  to  symptoms  usually  men- 
tioned, ribs  depressed  and  tenderness  at  angles  of 
ribs  covering  effected  part  of  lung.  Also  marked 
tenderness  in  intercostal  spaces,  and  at  the  costo- 
chondral  articulations.  The  spine  is  invariably 
straight  or  anterior  in  the  dorsal  region,  the  nor- 
mal curve  being  practically  obliterated. 

Rarely  a  turned  rib  or,  perhaps,  two  or  three 
will  be  the  sole  cause  of  the  symptoms  in  suspected 
cases.  See  that  clavicles  are  not  depressed. 

Treatment.  Treat  vigorously  in  the  dorsal 
region  from  first  to  eighth.  Pay  particular  ,  tten- 


73 

tion  to  the  circulation.  Inhibit  at  inferior  cervical 
ganglion  to  reduce  rate  of  heart  beat.  Raise  the 
ribs  by  any  method.  Separate  them  anteriorly  by 
placing-  fingers  between  the  ribs  with  palmar  sur- 
faces flat  downward,  press  gently  and  turn  the 
hand.  Place  patient  on  a  stool  wdth  knee  in  back, 
draw  arms  upwards  and  backwards,  the  patient 
inhaling-  deeply.  Night-sweats  are  controlled  by 
strong-  inhibition  in  dorsal  region.  Keep  patient 
out  doors  as  much  as  possible  with  some  light  occu- 
pation; insist  on  light  exercise  and  sunlight. 

Prognosis.  Favorable  in  early  stages.  In 
advanced  cases  there  is  no  hope  of  complete  cure. 
Unpleasant  symptoms  can  be  abated  in  all  cases 
and  patient  made  easy. 

Diet.  The  diet  is  of  primary  importance.  Idi- 
osyncracies  must  be  consulted,  but  meats,  ripe 
fruits  and  fats  are  the  basis.  Cream,  butter,  oils 
and  eggs,  unless  there  is  gastric  trouble.  In  emaci- 
ation there  is  nothing  better  than  cod  liver  oil.  It 
should  be  discontinued  in  case  it  interferes  with 
digestion.  Nutrition  is  the  key  to  recovery. 


CONVULSIONS. 

If  from  poisonings,  of  course  the  proper  antidote 
is  indicated.  Look  for  phimosis,  otitis,  indigestios, 
teething,  worms,  etc.  To  check  the  convulsion, 
grasp  the  head  firmly,  one  hand  on  forehead  and 
the  thumb  and  second  finger  of  the  other  in  the 


74 

sub-occipital  region.  Bend  head  strongly  back- 
ward. Hold  in  this  position.  An  assistant  grasp- 
ing- the  ankles  and  putting-  extending-  force  on  spine 
is  also  helpful.  Free  the  neck  so  as  to  give  perfect 
drainag-e  to  the  brain. 

Knead  the  abdomen  in  intestinal  and  g-astric 
troubles. 

In  convulsions  from  dentition  a  hot  bath,  95  to 
96°  F.,  is  recommended,  with  cold  applications  to 
head. 

Prognosis.     Good. 


COUGH. 

Treatment  will  depend  on  the  nature  of  coug-h. 
In  many  cases  it  is  due  to  an  elong-ated  uvula.  For 
this,  dip  fing-er  in  cold  water  and  g-ently  manipulate 
the  palate  and  uvula.  In  case  it  is  pharyng-eal  look 
for  lesions  in  upper  and  middle  cervical.  If  bron- 
chial, the  lesion  is  usually  at  second  or  fourth 
dorsal  or  along-  the  corresponding-  ribs.  In  all 
cases  thoroug-hly  relax  the  muscles  of  the  neck. 
Then  inhibit  by  steady  pressure,  slowly  moving- 

PLATE  16. 

Correcting  a  Posterior  Vertebra.  Muscles  of  back  must  be 
thoroughly  relaxed.  Then  patient  takes  position  as  shown. 
Physician  presses  steadily  at  several  points  of  spine  until 
the  patient  is  thoroughly  relaxed.  Then  the  thumbs  are 
placed  at  the  transverse  processes  of  the  displaced  vertebra 
and  sudden  pressure  is  applied.  This  will  usually  correct 
the  trouble  in  a  few  treatments.  It  is  sometimes  necessary 
to  give  a  month's  treatment  by  way  of  preparation.  Plac- 
ing one  hand  on  the  vertebra  and  with  the  other  swinging 
the  head  and  chest  from  side  to  side  will  produce  the  desired 
result. 


76 

the  hand  downward  over  the  trachea  on  either  side 
from  the  first  ring-  of  trachea  downward  to  ster- 
num. 

Relax  the  sterno-hyoid  and  sterno-thyroid  mus- 
cles. Contracted  muscles  often  cause  the  irritation 
here. 

Pressure  at  the  third  dorsal  will  usually  relieve 
the  paroxysm.  In  pneumonia  and  other  pulmonary 
troubles  it  is  very  necessary  to  be  able  to  relieve 
the  coughing-  as  it  prevents  exhaustion.  The  point 
will  usually  be  found  from  second  to  fifth  dorsal,  at 
which  place  steady  pressure  and  throwing-  the  ribs 
upward  will  be  efficacious. 

Remember,  a  coug-h  may  be  symptomatic  of 
many  troubles;  find  the  cause;  it  may  be  from  any 
org-an  of  the  body. 


CROUP. 

Thoroug-hly  relax  all  muscles  of  the  neck;  steady 
and  prolong-ed  work  is  necessary.  Extend  the  neck 
forcefully.  Work  downward  over  the  jug-ulars  to 
secure  drainag-e.  Dip  fing-er  in  cold  water  and 
stimulate  pharynx.  Use  cold  compresses;  flannel 
cloths  wrung-  from  ice  water  wrapped  closely  about 
the  neck  give  instantaneous  relief  in  many  cases. 
The  nerves  involved  are  the  ninth,  tenth  and 
eleventh  cranial  and  the  sympathetic.  In  chronic 
cases  trouble  will  be  found  in  cervical  vertebrae. 

In  case  emesis  is  desired  thrust  fing-er  down 
fauces  or  use  ordinary  emetics. 


77 

/;/  diphtheria  and  membraneous  croup  isolation 
and  disinfection  are  necessary.  A  disinfecting- 
spray  is  necessary  to  the  diseased  part.  Bichloride 
of  mercury  1:  1000  or  2000  is  perhaps  best.  Car- 
bolic 3  per  cent  solution  in  30  per  cent  alcohol  is 
much  used.  Boric  acid  and  hydrogen  peroxide  are 
also  used.  Follow  usual  methods  of  reducing-  the 
fever. 

Prognosis,     Good  if  case  is  taken  early. 


CURVATURE. 

If  pronounced,  suspect  tubercular  trouble  and 
seek  for  history.  Examine  carefully  the  condition 
of  the  organs  of  the  chest.  The  heart  and  lung's 
may  be  causes  of  this  condition.  Look  to  the  con- 
dition of  the  ribs.  Depressed  ribs  and  elevated 
costal  cartilages  are  often  secondary,  yet  must 
receive  special  treatment. 

In  all  cases  of  curvature  except  those  from  lack 
of  osseous  development  thoroug-h  relaxation  is 
required.  Extension  either  on  swing-  or  table  is 
the  first  step.  Steady  pressure  is 'put  on  the  deep 
muscles  of  the  spine  for  thoroug-h  relaxation. 

In  case  of  imperfect  hardening-  of  the  bones 
cereal  foods,  morning-  baths  and  gymnastics,  etc., 
together  with  extension  of  spine  followed  by  stim- 
ulation will  correct  the  troubles. 


78 

ANTERIOR  CURVATURE. 

In  all  lesions  the  theory  is  to  thoroughly  relax 
the  part,  then  increase  the  dislocation  and  on  move- 
ment in  opposite  direction  the  tendency  is  to  over- 
come the  luxation.  After  a  thorough  extension 
and  relaxation,  the  patient  should  be  placed  on 
stool;  the  physician  standing-  behind  places  knee  in 
back  just  below  the  vertebrae  which  are  anterior. 
Passing-  his  arms  below  those  of  the  patient  he 
takes  hold  of  the  ribs  corresponding-  to  vertebrae 
to  be  corrected.  As  the  patient  takes  a  deep 
inhalation,  strong-  traction  is  made  ag-ainst  the  ribs, 
the  knee  being-  held  firmly  in  position.  Another 
method  is  to  have  patient  recline  on  table — the 
patient's  legs  and  thighs  are  flexed  and  the  physi- 
cian and  an  assistant  stand  on  either  side,  the 
hands  are  placed  beneath  the  vertebra  above  the 
one  to  be  set;  using  this  as  a  fulcrum,  the  spine  is 
forced  backward  by  turning  the  body  and  legs  up 
towards  the  head.  This  is  a  successful  method. 
This  movement  is  not  to  be  given  in  man}7  cases. 
It  is  successful,  from  sixth  dorsal  downward.  In 
the  upper  dorsal  region  the  anterior  tendency  may 

PLATE  17. 

Relaxing  Muscles  of  Shoulder.  Patient  lies  on  side  facing 
physician.  With  one  hand  swing  the  arm  forward  and  up- 
ward. This  puts  the  muscles  attached  to  scapula  poster- 
iorly on  a  stretch.  Now  press  upon  the  muscles  between 
the  vertebral  border  of  the  scapula  and  the  spines  at  the 
same  time  moving  the  arm.  By  placing  the  thumb  against 
a  depressed  rib  it  may  be  thrown  into  place  by  this  move- 
ment. 


80 

be  overcome  by  having-  the  patient  thoroughly 
relaxed  on  back.  Elevate  the  head  and  shoulders, 
bending-  the  upper  part  of  the  spine  upon  the  ver- 
tebra below  the  one  to  be  set. 

A  g-ood  method  is  to  have  the  patient  clasp  his 
hands  behind  his  neck;  standing-  behind,  pass  your 
arms  beneath  his,  clasp  his  wrists,  force  the  head 
forward  and  sway  the  body  from  side  to  side. 
This  will  correct  any  anterior  tendency.  Must  be 
used  cautiously. 


POSTERIOR   CURVATURE. 

First,  seat  patient  on  stool.  Standing  at  the 
side  pass  one  arm  around  in  front  and  back  to  angle 
of  rib  corresponding  to  vertebra  involved.  Lift- 
ing upward  with  this  arm,  at  the  same  time  sway 
the  body  first  forward  to  the  limit  and  then,  press- 
ing with  the  free  hand  on  veterbra  to  be  corrected, 
throw  the  body  suddenly  backward. 

A  very  good  method  is  to  have  the  patient  lie  on 
his  face  thoroughly  relaxed.  The  physician  gently 
presses  on  the  transverse  processes  of  the  vertebra 
in  succession  until  the  one  which  is  posterior  is 
reached,  then  in  additon  to  the  steady  pressure  the 
physician  throws  sudden  weight  upon  the  vertebra 
and  it  is  slipped  into  place.  A  little  practice  will 
make  one  an  adept.  Care  must  be  used  in  case  of 
a  fragile  patient. 

Practicallv  the   same   movements  are    used    in 


81 

overcoming-  a  lumbar  curvature,  varying-  the  move- 
ments to  suit  the  changed  condition. 


LATERAL   CURVATURE. 

You  will  find  the  usual  contracture  and  tendon- 
ous  condition  of  the  muscles.  This  contracture 
may  be  overcome  by  repeated  application  of  steady 
pressure,  although  it  may  require  some  time  to 
accomplish  this.  At  each  treatment  the  patient 
should  be  placed  on  his  face  and  the  spine  made 
fixed  at  the  curvature,  the  body  swung-  from  side 
to  side  as  above  indicated.  Extension  is  most 
valuable.  Have  the  feet  fastened,  or  an  assistant 
may  hold  them,  while  you  reach  under  the  arms  so 
as  to  put  the  force  on  the  spine.  The  "swing-"  is 
a  g-ood  method  of  treating  curvature.  Swing-ing 
from  a  bar  by  the  arms  is  always  to  be  recom- 
mended, as  well  as  gymnastics,  physical  culture,  etc. 

In  all  spinal  curvatures  in  which  there  has  been 
no  extended  destruction  of  bone  tissue,  these 
measures  will  be  successful.  The  time  will  vary 
from  two  to  thirty  months,  according  to  the  severity 
of  the  case. 

When  there  is  evidence  of  active  tubercular  pro- 
cesses little  can  be  expected.  In  all  cases  the  cir- 
culation to  the  spine  can  be  greatly  improved  by 
thorough  manipulation  along  the  spine  and  by  the 
foregoing  movements  very  g-ently  applied. 


82 

DEMENTIA. 

In  dementia  the  lesion  is  to  be  found  in  the  neck 
or  else  in  the  region  controlling-  the  genital  organs. 
The  causes  being-  so  varied  and  the  lesions  so 
widely  remote  it  is  impossible  to  give  a  definite 
treatment.  A  careful  examination  of  the  spine, 
finding-  the  lesion  and  correcting  it  will  be  followed 
by  a  recovery.  It  must  be  remembered  that  in 
many  cases  no  osteopathic  lesions  can  be  found. 
The  causes  in  these  cases  being-  idiopathic,  little  or 
nothing  can  be  promised. 


DIABETES. 

Lesion  is  found  from  eighth  dorsal  to  second 
lumbar.  Occasionally  lower. 

Treatment.  Correct  lesion  in  this  region.  Strong 
inhibition  down  spine  from  lower  dorsal  to  sacrum. 
Even  the  bladder  region,  second  and  third  sacral, 
may  profitably  be  inhibited.  Also  in  the  ischio- 

PLATE  18. 

Setting  an  Eleventh  or  Twelfth  Rib.  The  cut  shows  the 
position.  Patient's  legs  must  be  flexed  so  as  to  give  com- 
plete relaxation  of  the  abdominal  wall.  The  quadratus 
lumborum  must  be  freed  from  contracture.  Place  one  hand 
on  the  rib  near  its  head,  the  other  near  the  free  end,  then 
approximate  the  ends  as  the  patient  takes  a  deep  inhalation. 
Now  turn  the  rib  to  its  natural  position  and  release  it  as  the 
patient  exhales.  Frequently  these  ribs  are  turned  upward, 
passing  beneath  the  rib  next  above.  Sometimes  adhesions 
have  formed,  to  break  which  causes  great  pain. 

Dislocations  of  these  ribs  are  frequent  causes  of  pain  in 
the  side,  stitches,  uterine  and  ovarian  symptoms.  Look 
carefully  to  these  in  case  of  appendicitis,  typhilitis,  colitis 
and  similar  troubles. 


84 

rectal  fossa.  Correction  of  above  named  lesions 
will  cure  in  most  cases.  Place  patient  on  back, 
flex  leg-  and  thig-h,  and  leaning-  over  patient  place 
hands  beneath  the  dorsal  and  lumbar  spine  and 
spring-  it  forward. 

Another  method.  Patient  on  side,  physician 
standing-  in  front,  flex  the  leg's  by  putting- 
them  ag-ainst  your  side  or  hip  and  reaching-over,  place 
your  fing-ers  on  side  of  spinous  processes  and 
spring-  the  spine  forward.  Or  have  patient  sit  on 
stool,  stand  in  front  and  have  patient  extend  arms 
across  your  shoulders.  Strong-ly  grasp  and  press 
forward  the  dorsal  and  lumbar  spinal  reg-ions,  at 
the  same  time  lifting-  the  shoulders  and  throwing- 
them  backward. 

Prognosis.     Must  be  g-uarded. 

Diet.  Meat  and  soup  broths,  eg-g-s,  fresh  fish  of 
all  kinds,  fowls  and  game,  olive  oil,  fats,  butter  and 
g-luten  bread.  Saccharin  must  be  used  instead  of 
sug-ar.  Following- veg-e tables  may  be  allowed:  Dan- 
delion, horseradish,  celery,  lettuce  and  cranberries. 

Avoid  breads,  potatoes  and  other  starches,  sweets 
of  all  kinds  and  liver. 


DIARRHCEA. 

Diarrhoea  is  controlled  by  extention  of  the  spine 
and  by  spring-ing-  the  spine  forward  in  the  lumbar 
and  lower  dorsal  region.  The  patient  is  first 
extended  with  force,  the  shoulders  and  ankles 
being-  the  points  of  traction.  He  is  next  laid  on  his 


85 

face  and  a  quiet,  steady  pressure  is-  applied  on 
either  side  of  the  spine  from  the  middle  dorsal 
region  to  the  coccyx.  This  will  occupy  about  ten 
minutes.  One  hand  is  then  placed  in  the  lumbar 
region  of  the  spine,  while  the  leg's  are  strongly 
extended  backward.  This  will  usually  be  sufficient 
in  acute  cases.  An  enema  of  warm  water  is  help- 
ful. Withhold  food  and  curtail  the  drink  for  twelve 
hours. 

Prognosis.     Good. 

Diet.  Diet  and  drinks  must  be  restricted. 
Boiled  milk  and  arrow  root  may  be  given  when 
strength  is  impaired.  Return  to  the  usual  diet 
gradually;  oatmeal  water,  barley  water,  corn-starch 
pudding-,  broths  and  dry  toast  are  allowable. 


DIPHTHERIA. 

Treatment  same  as    for  membraneous  croup, 
which  see.     Strict  isolation  is  imperative. 


DYSENTERY. 

A  displacement  of  the  vertebrae  at  third  and 
fourth  lumbar  is  almost  invariably  found.  Correct 
this  at  once.  Then  give  strong-  and  continued 
inhibition  over  the  sacral  region.  The  abdomen 
should  be  treated  by  steady  pressure  over  the 
solar  and  inferior  mesenteric  plexuses.  In  many 
cases  one  or  two  treatments  will  suffice.  In  others 


86 

it  is  necessary  to   repeat  the    treatment  several 
times. 

Prognosis.     Good. 

Diet.     Same  as  in  diarrhoea,  q  .v. 


DYSPEPSIA. 

The  lesion  is  usually  found  in  the  region  lying 
between  the  second  and  sixth  dorsal.  Occasion- 
ally it  may  involve  the  intestines  as  well  as  the 
stomach,  in  which  condition  the  lesion  may  be 
found  lower  in  the  dorsal  region.  Rarely  does  a 
lesion  in  the  cervical  region  affect  the  stomach — 
such  conditions  being-  coincident  rather  than  caus- 
ative. There  may  be  an  irreg-ularity  of  the  car- 
tilag-es  of  any  of  the  ribs  overlying-  the  stomach. 
The  gases  present  may  be  removed  by  steady 
pressure  over  the  stomach — either  absorbing  them 

PLATE  19. 

Treatment  of  th?  Liver  The  patient  lies  on  left  side 
with  legs  flexed.  Press  firmly  over  the  seventh  to  ninth 
ribs  inclusive  and  place  the  other  hand  just  at  margin  of 
the  cartilage  of  those  ribs.  Have  the  patient  inhale  deeply 
and  follow  with  a  forced  exhalation.  As  the  breath  is  forced 
outward  the  hand  presses  deeply  beneath  the  ribs.  This 
stimulates  peristalsis  of  the  ducts  of  the  liver  and  empties 
the  cyst.  After  this  treatment  with  the  hands  as  in  cut,  press 
steady  with  the  hand  anteriorly  and  vibrate  the  liver  by 
striking  the  heel  of  the  other  hand  against  the  ribs.  This 
will  produce  a  rapid  change  of  blood  in  the  liver  and 
increase  its  activity.  The  above  treatments  may  be  given 
with  patient  lying  on  back  Follow  this  with  a  treatment 
over  the  line  of  the  gall  duct  downward  from  the  point  of 
the  ninth  rib  toward  the  middle  line,  about  one  and  one- 
half  inches  above  the  umbilicus.  Treat  the  liver  in  all 
intestinal  troubles,  haemorrhoids,  malaria,  rheumatism, 
headaches,  indigestion,  neuritis  and  in  most  acute  diseases. 


88 

or  in  many  cases  forcing-  them  down  the  intestines 
— pressure  serving-  to  relax  the  muscular  walls. 
-The  bowels  and  kidneys  must  be  kept  active.  Out- 
door exercise  is  advisable. 

Prognosis.     Favorable. 

Diet.  No  specific  diet  can  be  prescribed  but 
the  following-  are  allowable:  Cereals,  breakfast 
foods,  etc.,  chicken,  turkey,  broiled  beefsteaks, 
fish  (boiled  or  broiled),  oysters  and  light  veg-e tables, 
such  as  peas  and  lettuce. 

Avoid  rich  soups,  gravies,  condiments,  pickles, 
fresh  bread,  sug-ars,  tea,  coffee,  tobacco,  very  acid 
or  very  sweet  fruits. 

DIZZINESS. 

The  causes  may  be  various.  Some  of  the  com- 
moner ones  being-  from  the  eyes,  the  stomach,  the 
liver,  the  kidneys  and  the  circulatory  system. 
Examination  will  reveal  the  source  of  the  trouble. 
In  many  instances  the  g-lasses  are  at  fault.  Should 
it  prove  to  be  a  vaso-motor  disturbance  the  trouble 
is  usually  to  be  found  in  the  cervical  region.  To 
relieve  this  condition  press  deeply  beneath  the 
clavicle  so  as  to  reach  the  fibers  of  the  cardiac 
plexus.  Throw  the  head  well  back,  holding-  strong-ly 
with  one  hand  at  the  junction  of  occiput  and  atlas. 

Draw  the  hands  firmly  downward  over  the  lines 
of  the  jug-ulars.  Raise  the  clavicles.  Treat  the 


89 

various    organs    affected.       Correct    the    cervical 
lesions. 

Prognosis.     Good. 


EAR — DEAFNESS. 

Always  examine  with  endoscope  for  perforated 
membrane  and  for  accumulation  of  cerumen. 
Lesion  is  usually  found  from  second  to  fourth  cervi- 
cal vertebrae.  Sometimes  disturbance  in  the  vaso- 
motors  as  remote  as  the  lower  cervical  may  produce 
disturbance.  Contractures  of  the  scaleni,  the 
sterno-cleido-mastoid,  the  omo-hyoid  or  the  digas- 
tric may  produce  disease  of  the  ear. 

Treatment.  Reach  the  great  occipital  at  the 
second  cervical  and  at  the  basi-occiput;  the  seventh, 
at  its  exit  from  the  stylo-mastoid  foramen;  the 
ninth  and  tenth  at  their  exit  from  the  jugular 
foramen  just  posterior  and  inferior  to  the  lobule 
of  the  ear.  Thorough  relaxation  of  the  tissues  in 
this  region  is  very  beneficial.  In  addition,  the  finger 
should  be  inserted  in  the  mouth  and  the  tonsils  and 
the  openings  of  the  Eustachian  tubes  thoroughly 
stimulated.  Cerumen  should  be  removed  with  oil 
and  soapsuds. 

Prognosis.  If  trouble  is  catarrhal,  favorable;  if 
from  other  causes,  doubtful. 


ECZEMA. 

If  the  eruption  is  local,  then  it  is  certain  that  an 
interference  in  the  drainage  of  that  region,  either 


90 

lymphatic  or  venous,  is  the  exciting-  cause.  The 
causa  causans  is  either  a  disturbance  in  the  cervical 
sympathetics  or  else  at  the  kidney  center,  inter- 
fering- with  excretion.  The  atlas  and  axis  are 
frequently  misplaced,  particularly  in  case  of  eczema 
of  the  head  and  face.  The  bowels  and  kidneys 
should  be  kept  open  and  the  stomach  in  g-ood  con- 
dition. By  watching-  the  diet  carefully  it  is  possible 
to  make  this  a  valuable  adjunct  to  the  treatment. 

Treatment.  Correct  any  lesions  in  the  cervical 
region  (see  cervical  vertebrae).  Next  treat  kidneys 
and  bowels  thoroughly  (see  kidneys  and  bowels). 
Cleanse  the  affected  parts  with  a  solution  of  hot 
boracic  acid  twice  daily. 

Prognosis.     Most  cases  can  be  cured. 

Diet.  The  diet  should  be  wholesome  and 
nourishing-.  Remember,  that  more  than  half  the 
cases  are  from  too  much  or  improper  food.  Milk, 
whole-wheat  bread,  fresh  veg-etables  plainly  cooked, 
chicken  and  fresh  fish;  meats  very  sparingly;  oat- 
meal is  often  injurious. 

Avoid  pastry,  sweets,  sauces,  rich  soups  and 
heavy  veg-etables. 

PLATE  20. 

Stretching  the  Sciatic  Nerve.  Patient  lies  on  back.  The 
leg  is  flexed  on  thigh  and  the  thigh  on  abdomen.  Then  with 
the  thigh  still  flexed  straighten  the  limb  by  extending  the  leg 
on  the  thigh.  This  is  a  necessary  treatment  in  sciatica  or 
in  neuritis  of  the  sciatic  nerve.  Care  is  necessary,  as  the 
treatment  may  be  quite  painful.  This  treatment  should  be 
preceded  by  a  thorough  relaxation  of  the  tissues  around  the 
sacro-sciatic  notch,  and  by  strong  internal  rotation  of  the 
thigh,  to  relax  the  pyriformis  and  gemelli  muscles. 


92 

EMPHYSEMA. 

This  disease  is  a  sequel  of  other  disturbances 
and  represents  changes  which  have  taken  place  in 
the  lung-  tissue. 

Lesion.  In  the  lung-  region  of  the  spine  or  else 
in  the  cervical  sympathetic.  The  vagus  may  be 
involved.  The  costal  lesions  are  compensatory 
and  cannot  be  considered  in  the  light  of  causes. 

For  treatment.  Correction  of  the  spinal  and  cos- 
tal lesions.  The  liver  and  heart  must  be  carefully 
watched  as  these  two  organs  are  closely  associated 
with  the  general  condition  of  the  blood.  The  only 
hopes  of  benefit  is  through  the  general  vaso-motors 
and  the  vagal  branches  to  the  bronchial  tubes,  the 
vaso-motors  to  the  lungs. 

Prognosis.  Little  can  be  done;  there  is  no  hope 
of  curing  cases  of  long  standing. 

ENDOCARDITIS. 

In  acute  cases  rest  and  nourishing  diet  are  the 
first  essentials. 

Lesion.  Tenderness  will  be  found  in  the  dorsal 
region  from  the  third  to  the  sixth,  usually  at  the 
fourth  and  fifth. 

Treatment.  Treat  by  strong  inhibition  ante- 
riorly at  fifth  and  sixth  cervical,  also  at  head  of 
first  rib  and  annulus  of  Vieussens.  Raise  the  ribs 
gently  but  strongly. 

In  chronic  cases  the  ribs  should  be  raised  on  left 
side.  In  many  cases  there  is  a  displacement  of  the 


93 

first  rib  upward,  interfering-  with  the  inferior  cer- 
vical ganglion.  The  fifth  rib  is  usually  displaced 
downward  and  correction  of  this  lesion  will  be 
followed  by  marked  improvment.  In  case  there  is 
mitral  incompetency,  the  condition  of  the  lower 
ribs  and  the  diaphragm  must  be  examined  care- 
fully. The  diaphragm  may  by  traction  on  the 
aorta  occlude  its  lumen. 

Prognosis.     Treatment  is  helpful. 

Diet.     (See  heart  troubles.) 


ENTERALGIA    (TORMINA,    GRIPES). 

The  lesion  may  be  found  anywhere  in  the  dorsal 
or  lumbar  vertebra,  usually  in  lower  dorsal  and 
upper  lumbar.  Some  error  in  diet  is  usually  the 
exciting-  cause;  this  should  be  carefully  g-uarded 
until  the  recovery  is  complete. 

Treatment.  Control  by  steady  pressure  in  the 
splanchnic  region.  Relaxation  by  steady  pressure 
in  the  lumbar  region  is  helpful.  The  knee  in  the 
dorso-lumbar  region,  the  spine  being  thrown  back- 
ward, is  usually  sufficient  to  quiet  the  peristalsis. 
Steady  pressure  over  the  solar  and  mesenteric 
plexuses  corrects  flatulency  and  quiets  peristalsis. 
Hot  fomentations  applied  to  abdomen  or  a  hot 
bath  will  relieve  the  pain.  The  liver  should  be 
treated  to  throw  the  bile  into  the  intestines  to  pre- 
vent decomposition.  Impaction,  etc.,  must  be 
relieved. 


94 

Prognosis.     Cure  is  almost  certain  and  perma- 
nent. 


ENTERITIS. 

Lesion.  Usually  found  at  second  to  fourth  lum- 
bar. 

Treatment.  Correct  lesion.  Spring-  the  spine 
forward  and  give  strong-  inhibition  at  the  lower 
dorsal  and  lumbar,  region.  Use  irrigation  for  the 
larg-e  intestines;  cool  or  cold  water.  Rest  in  bed, 
and  a  proper  diet  in  connection  with  treatment 
three  to  five  times  daily,  will  effect  a  cure. 

Prognosis.     Good. 

Diet.  Broths,  eg-g-  albumen  and  beef  juice  are 
the  proper  food. 

Avoid  over  feeding-. 


EPILEPSY. 

Lesion.  Lesions  are  as  various  as  the  causes. 
Most  osteopathic  cases  show  marked  lesions  in  the* 
cervical  regions,  but  this  is  not  always  the  case. 
Occasionally  a  single  lesion  in  the  dorsal  region  is 

PLATE  21. 

Pressure  on  the  Fifth  Nerve.  The  plate  shows  five  points 
at  which  pressure  may  be  applied  to  the  fifth  nerve.  They 
are  at  the  mental  foramen,  below  the  malar  bone,  just  in 
front  of  the  tragus  of  the  ear  and  slightly  above  it,  at  the 
inner  canthus  of  the  eye  and  at  the  supra-orbital  foramen. 
Gentle  manipulation  around  these  points  will  be  effective  in 
quieting  a  nervous  headache,  neuralgia,  and  similar  con- 
ditions. In  case  of  chronic  catarrh,  coryza,  etc.,  these 
points  are  very  important. 


the  entire  cause.  Rarely  it  is  a  reflex  from  uterine 
disturbances,  phimosis,  or  masturbation,  in  which 
cases  there  will  be  secondary  lesions  in  the  lumbar 
region.  In  case  no  lesion  is  apparent  and  the  case 
is  of  long-  standing-,  there  is  little  hope  for  success. 

Treatment.  The  treatment  will  vary  with  the 
lesions,  but  the  neck  must  always  be  carefully 
treated  for  the  circulation  to  the  brain.  The  spine 
must  be  thoroughly  relaxed  and  the  irritation  to 
the  nervous  system  released.  A  healthful  attitude 
of  mind  on  the  part  of  the  patient  is  essential  as 
is  outdoor  exercise. 

Prognosis.  Unfavorable;  several  months  are 
required  to  accomplish  anything. 

Diet.     Nourishing  diet;  meat  sparingly. 


ERYSIPELAS. 

Few  cases  have  been  treated  osteopathically,  but 
those  have  been  with  uniform  success. 

Lesion.  The  lesion  is  usually  found  in  the  cer- 
vical region,  either  in  the  vertebrae  themselves  or 
the  muscles. 

Treatment.  Restlessness  is  overcome  by  spong- 
ing in  cool  or  tepid  water  and  by  thorough  manip- 
ulation down  the  spine.  Thorough  drainag-e  must 
be  secured,  and  treatment  of  the  lesions  usually 
found  in  the  cervical  region,  or  as  low  as  the  fourth 
dorsal,  is  effective. 


97 

Avoid  local  treatments  and  confinement  cases 
while  attending-  erysipelas.  Cold  water  is  perhaps 
the  best  application. 

Prognosis.     Good. 

Diet.  Food  in  small  quantities,  an  ounce  every 
hour;  pancreatinized  milk,  beef  juice,  egg-nog  and 
gruel. 

EPISTAXIS. 

Stimulate  the  superior  cervical  ganglion.  Steady 
pressure  at  inner  canthus  of  eye.  Thorough 
relaxation  of  the  muscles  over  jugulars  is  indicated. 
Raise  arms  over  head.  Compress  the  facial  artery 
at  angle  of  inferior  maxillary.  Ice  may  be  applied 
at  basi-occiput.  In  extreme  cases  the  anterior  and 
posterior  nares  may  be  plugged. 

Prognosis.     Good. 

EXOPHTHALMIC   GOITRE. 

Three  symptoms — exophthalmus,  enlargement 
of  the  thyroid  gland  and  a  rapid  and  peculiar  heart 
beat — are  usually  present,  but  only  two  of  the  three 
may  be.  Occasionally  complications  may  occur. 

Lesion.  In  cervical  vertebra  usually  the  fifth  or 
sixth,  lateral;  at  the  last  cervical  vertebra;  or  the 
upward  dislocation  of  the  first  rib;  also  the  fifth 
rib  on  the  left  side  may  be  involved. 

Vaso-motor  fibers  may  come  from  the  third  dor- 
sal nerve  to  the  thyroid;  hence  the  lesion  produc- 
ing vaso-motor  change  in  the  gland  may  be  from 


98 

this  region.  The  eye  should  be  gently  manipulated 
and  a  relaxing-  treatment  over  the  line  of  the 
internal  carotid  artery  is  suggested.  The  region 
just  below  the  ear  is  very  important.  Keep  the 
upper  ribs  raised  and  the  upper  dorsal  spine 
thoroug-hly  relaxed. 

Prognosis.  Thirty-three  percent  cured;  major- 
ity helped. 

THE   EYE. 

It  is  not  in  the  province  of  this  work  to  give  the 
minute  details  of  this  treatment  in  various  troubles 
which  affect  the  eye. 

Lesion.  The  lesion  is  usually  in  the  upper  cerv- 
ical region;  either  the  first,  second,  third  or  fourth. 
There  is  a  prevalent  idea  that  the  atlas  is  dislo- 
cated in  all  eye  troubles.  While  this  is  true  in  some 
cases,  yet  not  always  do  you  find  it  so.  Lesions 

PLATE  22. 

Treatment  of  Ninth,  Tenth  and  Eleventh  Nerves.  These 
three  make  their  exit  through  the  jugular  foramen  and  are 
intimately  associated  with  the  carotid  artery  and  the  jugu- 
lar vein.  The  ninth  nerve  is  of  first  importance  in  affections 
of  the  tonsils,  pharynx,  Eustachian  tubes,  and  middle  ear. 
The  tenth  nerve  is  both  sensory  and  motor  to  the  larynx;  is 
vaso-motor  to  the  lungs,  and  is  motor  to  the  stomach  and 
intestines,  as  well  as  inhibitory  to  the  heart. 

The  seventh  nerve  may  be  reached  below  the  lobule  of  the 
ear,  as  it  divides,  just  before  reaching  the  ramus  of  the  jaw. 
The  following  muscles  may  be  reached  and  relaxed  at  this 
point:  the  ster  no-mas  toid,  the  scaleni,  the  stylo-hyoid,  the 
digastric,  the  levator  anguli  scapulae,  splenius  and  trachelo- 
"mastoid.  The  importance  of  thoroughly  relaxing  these 
parts  and  of  restoring  the  normal  condition  to  this  region  in 
all  diseases  affecting  the  head  and  throat,  will  be  seen. 
Here  lie  the  vaso-motors  to  the  whole  region  as  well  as  the 
sensory  and  motor  nerves  to  the  larynx  and  throat. 


100 

are  also  found  at  the  first  rib  and  the  second  and 
third  dorsal  vertebrae  and  even  as  low  as  the  fifth. 

Treatment.  Find  and  correct  the  lesions. 
Additional  treatment  to  the  eyeball  should  be  given 
by  laying-  the  tips  of  the  fingers  lightly  on  the 
closed  lids,  tapping  these  lightly  and  rapidly  with 
the  fingers  of  the  other  hand.  By  placing  the 
thumb  and  forefinger,  one  at  either  canthus,  the 
eye  may  be  compressed.  By  gently  working  as 
far  back  of  the  eyeball  as  is  possible,  both  above 
and  below  and  laterally,  the  muscles  of  the  eye  may 
be  reached  and  relieved.  The  fifth  nerve  at  its 
various  points  of  exit, — on  the  eyelids,  at  inner 
canthus,  at  supra-orbital  notch,  and  infra-orbital 
foramen,  should  be  treated  chiefly  by  inhibition. 
The  inferior  maxillary  branch  may  be  reached 
below  the  tempero-maxillary  articulation.  If  the 
circulation  or  drainage  of  the  eye  is  interfered 
with,  the  application  of  hot  and  cold  water  alter- 
nately is  recommended. 

Prognosis.     Very  favorable  in  most  troubles. 


FEVER,   (PYREXJA.) 

The  general  treatment  for  pyrexia  is  as  follows: 
The  muscles  of  the  spine  are  thoroughly  relaxed, 
giving  particular  attention  to  the  splanchnic  region. 
The  ribs  over  the  heart,  third  to  sixth,  are  raised  and 
the  muscles  of  the  neck  are  thoroughly  relaxed. 
Steady  pressure  is  now  put  upon  the  sub-occipital 


101 

region,  the  hand  covering-  the  segment  from  the 
occiput  to  the  fifth  cervical  vertebra.  This 
diminishes  the  impulses  sent  in  from  the  cervical 
nerves  to  the  thermog-enic  center  in  the  corpus 
striatum;  next  place  the  thumb  and  finger  against 
the  atlas,  holding-  the  vertebral  arteries,  and 
strongly  bend  the  head  backwards.  This  should 
be  continued  for  some  five  or  six  minutes.  Press 
deeply  and  steadily  downward  at  the  head  of  the 
first  rib;  you  here  reach  the  aug-mentor  fibres  to 
the  heart. 

Next,  put  steady  pressure  on  abdomen  over 
the  solar  and  inferior  mesenteric  plexuses.  These 
steps  carefully  and  quietly  taken  will  usually 
reduce  the  rapidity  of  the  heart  beat,  and  after  a 
half  hour  will  reduce  the  temperature.  Sometimes 
it  is  necessary  to  repeat  the  treatment  within  two 
or  three  hours.  Do  not  allow  the  patient  to  take 
his  temperature  or  pulse.  A  cool  spong-e  bath  or  a 
dip  into  cool  water  is  a  very  safe  method  of  con- 
trolling- temperature. 

Prognosis.     Good. 

Diet.     Nutritious  foods.     Milk,  eg-g-s,  etc. 


FEVER,  SCARLET. 

There  is  no  disease  in  which  more  varied  com- 
plications may  occur  than  in  scarlet  fever,  and  for 
this  reason  the  utmost  vig-ilance  is  required  on  the 
part  of  the  physician.  The  ear  and  the  kidneys 


102 

are  the  organs  most  likely  to  be  affected.  The 
temperature  is  to  be  controlled  as  in  any  other 
fever,  by  holding-  the  sub-occipital  region  and  by 
inhibition  at  the  annulus  of  Vieussens.  A  g-entle 
manipulation  of  the  abdomen  with  steady  pressure 
on  the  abdominal  plexuses  will  aid  in  equalizing- 
the  circulation  and  in  reducing-  the  temperature. 
The  muscles  of  the  entire  spinal  region  must  be 
relaxed,  particular  attention  being-  given  to  the 
upper  dorsal  and  cervical  groups.  This  relieves 
the  hyperaemia  of  the  nerve  centers  and  restores 
normal  heart  action,  heat  production  and  dissemi- 
nation. By  careful  manipulation,  securing-  efficient 
drainag-e  of  the  neck,  the  inflammation  of  the  cer- 
vical lymphatic  glands,  so  apt  to  follow  cases  in 
wrhich  the  pharyng-eal  symptoms  were  severe,  can 
be  controlled  or  prevented. 

Should  arthritis  occur,  g-entle  manipulation  pro- 
ducing- drainag-e  is  required.  In  case  the  fever 
become  hig-h,  use  the  spong-e  bath,  and  if  delirium, 

PLATE  23. 

Stimulating  the  L  iver.  This  plate  shows  position  of 
hands  in  treatment  to  stimulate  the  liver  to  action.  The 
patient  breathes  deeply  and  as  he  exhales  the  hands  are 
pressed  upward  beneath  the  line  of  the  carlilage  on  the 
right  side.  This  will  arouse  the  muscle  fibres  in  the  cyst 
and  ducts  to  action  and  increase  the  flow  of  bile.  This 
position  is  used  also  in  treating-  stomach  and  intestinal 
troubles  through  the  solar  plexus.  This  may  be  reached  in 
the  middle  line  between  the  umbilicus  and  the  ensiform 
appendix,  much  closer  to  the  former.  Deep  and  steady 
pressure  here  will  relieve  high  blood  pressure  and  induce 
a  flow  of  blood  to  the  mesenteries,  aiding  digestion  and  in 
some  cases  relieving  headache  when  other  treatments  fail. 


104 

the  cold  pack  or  the  cold  bath  should  be  used.  A 
cold  compress  around  the  neck  will  relieve  the 
throat  symptoms.  Should  heart  action  become 
poor,  stimulation  of  the  inferior  cervical  ganglion 
and  separating-  the  ribs  will  be  successful.  If  the 
care  has  been  thorough  there  is  little  danger  of  any 
of  the  complications. 

Diet.  Milk,  a  small  amount  of  vanilla  ice  cream, 
lemonade  and  barley  water;  but  milk  should  form 
the  basis. 

Isolation  and  disinfection  must  be  rigidly  en- 
forced. 


GASTRITIS. 

This,  like  gastric  ulcer,  gastralgia,  gastrodynia 
and  related  troubles,  presents  no  lesions  differing 
from  those  of  dyspepsia.  The  diet  is  of  much 
importance  but  the  chief  reliance  must  be  in  cor- 
recting the  lesions  which  occur  either  in  the  ver- 
tebrae or  the  ribs  in  the  region  of  the  third  to  sixth, 
or  sometimes  the  seventh  or  eighth.  In  gastro- 
dynia and  gastralgia  the  trouble  is  frequently 
found  to  be  a  dislocated  or  turned  rib.  For  spe- 
cific lesions  and  treatment,  see  dyspepsia,  page  86. 


GOITRE 

Lesion  will  be  found  in  the  cervical,  or  the  upper 
dorsal  region.  The  clavicle  is  most  frequently 
depressed.  The  first  or  second  ribs  are  elevated. 
Thoroughly  relax  the  muscles  of  the  neck,  and  cor- 


105 

rect  the  lesions  in  the  cervical  vertebrae;  gently 
manipulate  the  gland  itself,  following-  the  direction 
of  its  drainage.  Treatment  similar  to  that  of 
exophthalmic  goitre  is  indicated. 

H^EMATEMESIS. 

Correct  any  lesion  in  the  splanchnic  region. 
Keep  the  head  low  and  the  patient  quiet.  Inhibi- 
tion of  the  vagi  will  quiet  the  peristalsis.  Hot  foot 
bath  or  dry  heat  applied  to  feet,  with  an  ice  bag 
over  abdomen  is  valuable. 


H^EMATURIA. 

Lesion  is  in  region  of  eleventh  dorsal  to  first 
lumbar.  Correct  this  and  thoroughly  inhibit  in 
the  lumbar  and  sacral  regions.  If  hemorrhage  is 
from  bladder  the  trouble  is  at  second  to  fifth  lum- 
bar. Ice  bags  should  be  applied  to  loins. 

Prognosis.     Favorable. 

HAEMOPTYSIS. 

This  is  usually  an  indication  of  tuberculosis.  It 
may  be  the  result  of  other  conditions,  as  menstrual 
disorders,  cardiac  troubles,  etc. 

To  stop  the  hemorrhage  is  in  many  cases  impos- 
sible. In  case  it  is  not  too  rapid,  it  may  be  checked 
by  having  patient  lie  in  bed.  Stimulation  of  the 
pneumogastric  nerve  will  reduce  blood  pressure  in 
the  pulmonary  system  by  acting  on  the  pressor 


106 

nerves  to  the  bronchial  vessels  and  by  decreasing- 
the    rapidity    and    streng-th    of    the    heart-beat. 
Cracked  ice  held  in  the  mouth  is  beneficial. 
Prognosis.     Uncertain. 


HAEMORRHOIDS — PILES. 

Constipation  is  a  frequent  complication,  and 
when  such  is  the  case  the  cure  of  this  condition 
will  usually  overcome  the  haemorrhoids.  Examine 
the  coccyx,  as  this  is  frequently  a  source  of  trouble; 
a  slipped  innominate,  or  a  lumbar  lesion,  is  often 
a  cause.  A  congested  'liver  causing-  stasis  in  the 
portal  circulation  is  oftimes  a  cause  of  poor  drain- 
age through  the  superior  haemorrhoidal  vein;  there- 
fore pay  especial  attention  to  the  liver.  Treat  the 
pudic  nerve,  and  especially  relax  structures  in  the 

PLATE  24. 

Correcting  a  Cervical  Lateral  Sub-dislocation.  Patient 
lies  on  back.  The  slip  is  carefully  and  accurately  located. 
The  muscles  and  ligaments  of  the  neck  must  be  thoroughly 
relaxed  by  a  series  of  treatments.  The  head  is  then  strongly 
bent  from  the  side  toward  which  the  slip  has  occurred. 
Now  with  finger  tips  of  the  hand  on  the  opposite  side,  press 
steadily  against  the  transverse  process  of  the  two  vertebra? 
next  below,  if  possible.  This  relaxes  the  ligaments  on  the 
opposite  side  and  draws  taut  those  on  the  side  of  the  slip. 
While  the  head  is  thus  strongly  flexed  it  is  slowly 
rotated  until  the  tension  becomes  pronounced.  No\\  a 
sudden  turn  of  perhaps  one  or  t^o  degrees  will  slip 
it  back  into  place.  This  treatment  may  have  to  be 
repeated  several  times  in  cases  of  long  standing.  In  chronic 
headaches,  neuralgias,  vaso-motor  disturbances,  eye  and 
ear  troubles,  this  treatment  is  frequently  a  very  effective 
remedy.  Great  care  is  necessary  as  there  is  a  limit  to  the 
force  which  may  be  employed. 


108 

ischio-rectal  region.     Stimulation  of  the  ganglion 
impar  is  helpful  to  the  drainage. 

Prognosis.     Usually  one  to  three  months'  treat- 
ment will  effect  a  cure. 

Diet.     Such  as  would  prevent  constipation  or 
diarrhoea. 


"SAY    FEVER. 

Lesion  in  cervical  region  interfering  with  nutri- 
tion to  the  mucous  membrane  of  the  nasal  passages. 

Treatment  at  the  points  of  emergence  of  the 
fifth  nerve  and  over  the  surface  of  the  nose  will 
give  relief. 

Steady  pressure  with  the  fingers  over  the  fron- 
tal sinuses  and  over  the  sinuses  of  the  superior 
maxillary  and  ethmoidal  bones,  and)  on  the  sides  of 
the  nose  will  also  relieve  the  symptoms.  Relax- 
ing the  muscles  at  the  occiput,  and  correcting  the 
lesion  in  the  cervical  region  will  make  the  cure 
permanent.  Treating  the  pharyngeal  plexus  and 
the  palatine  nerves  at  the  tonsils  and  over  the  hard 
palate  helps  the  condition.  Meckel's  ganglion  also 
sends  branches  to  the  nasal  fossa,  Which  are  both 
vaso-motor  and  trophic. 

Out-door|  exercise,  gymnastics,  baths,  etc.,  are 
adjuvants. 

Prognosis.     Favorable. 


HEADACHE. 

In  constant   or  periodic   headache,   lesion    may 
be    found     either    in    cervical,    upper    dorsal    or 


109 

in  lumbar  regions.  It  may  be  associated  as 
a  result  with  various  conditions.  To  make  the 
cure  permanent  these  conditions  must  be  cor- 
rected. The  usual  treatment  is  to  thoroughly  relax 
the  tissues  of  the  neck  and  of  the  upper  dorsal 
region.  Raise  the  clavicles,  secure  free  drainag-e 
for  the  brain  throug-h  the  jug-ular  veins  by  work- 
ing- downward  from  jug-ular  foramina  with  thumbs 
following-  line  of  veins.  Quiet  the  heart-beat  by 
steady  pressure  on  the  annulus.  Steady  pressure 
over  the  points  of  emerg-ence  of  the  fifth  nerve  will 
often  stop  the  pain  anteriorly,  while  pressure  on 
the  sub-  and  great  occipital  nerves  will  stop  a  pos- 
terior pain.  Firmly  holding-  the  sub-occipital 
reg-ion  and  throwing-  the  head  backward  will  stop 
the  flow  from  the  vertebral  arteries  and  at  the  same 
time  facilitate  drainag-e.  Press  g-ently  on  solar 
plexus;  give  thoroug-h  relaxation  in  the  splanchnic 
reg-ion. 

Prognosis.     Good. 

HEMICRANIA — SICK   HEADACHE — MIGRAINE. 

Reduce  the  heart  action  by  freeing-  the  ribs  on 
the  left  side  and  holding-  the  inferior  cervical  g-an- 
g-lia.  Should  there  be  nausea,  it  is  relieved  by 
elevating-  and  separating-  the  third  to  fifth  rib  on 
the  rig-ht  side.  Look  for  cervical  lesions  as  well  as 
in  other  regions.  The  treatment  is  similar  to  that 
for  headache,  q.  v. 


110 

HEMIPLEGIA. 

The  cause  may  be  either  cerebral  or  spinal. 
The  circulation  to  the  nerve  centers  must  be  main- 
tained by  relaxing  the  muscles  in  the  entire  spinal 
region  from  occiput  to  coccyx.  In  the  spinal  type  of 
hemiplegia  the  lesion  is  found  to  be  a  slipped  vertebra. 

There  will  be  marked  muscular  and  usually 
osseous  lesions  in  the  cervical  region  in  cerebral 
cases.  The  treatment  is  correction,  but  it  is  more. 
The  strongest  extension  must  be  used.  Every 
muscle  must  be  kneaded,  every  nerve  traced  and 
stimulated.  All  articulations,  even  to  the  phalan- 
g-eal  must  be  flexed  and  extended  at  each  treatment. 
Experience  shows  the  corrective  spinal  treatment 
should  be  given  three  times  each  week.  The  mus- 
cular, nerve  and  articular  manipulations  should  be 
given  daily. 

Keep  the  bowels,  kidneys  and  the  heart  in  g-ood 
condition. 

Prognosis.  Improvement  marked  and  perma- 
nent. A  complete  cure  is  rare. 

Diet. 

PLATE  25. 

Inhibiting  the  Abdominal  Plexus.  The  plate  shows  the 
position  of  the  hands  for  pressure  upon  the  solar  and  hypo- 
gastric  plexuses.  These  are  the  nervous  pathway  for  most 
of  the  impulses  reaching  the  abdominal  and  pelvic  viscera. 
In  case  of  tenderness,  inflammation  or  congestion  of  any  of 
these  organs,  steady  pressure  at  one  or  both  these  points  is 
indicated.  A  gentle  rotary  motion  of  the  hands  will  remove 
venous  blood  and  free  the  parts  from  tenderness.  This 
treatment  is  indicated  in  peritonitis,  diarrhoea,  flux  and  in 
acute  pelvic  disorders.  It  will  frequently  remove  gases 
from  the  bowels  in  flatulency. 


112 

HICCOUGH. 

Inhibit  the  phrenic  nerve  over  the  third,  fourth 
and  fifth  cervical.  If  severe,  treat  splanchnic  area. 
Often  associated  with  other  diseases,  affecting-  the 
nervous  system.  Direct  treatment  to  diaphragm 
is  indicated. 


HIVES — URTICARIA. 

Lesion  may  be  remote.  This  is  a  reflex  from 
various  causes,  such  as  intestinal,  gastric,  uterine, 
ovarian,  renal  or  nervous  troubles.  The  whole 
spine  must  be  examined  and  patient  questioned  for 
other  symptoms.  Irregularities  in  diet  must  be 
corrected.  Give  a  general  treatment  to  equalize 
the  circulation  and  treat  the  special  conditions 
according  to  requirements. 


HERPES. 

Occurring  along  the  distribution  of  a  certain 
nerve,  it  clearly  has  a  local  cause.  We  treat  it  as 
due  to  a  neurosis  of  the  nerve  caused  by  a  failure  of 
the  veins  and  capillaries  to  drain  the  region.  Seek 
for  the  impediment — usually  a  contracted  muscle. 
A  few  local  treatments  daily  along  the  course  of  the 
nerve  is  effectual. 


HYPER^EMIA OF    ANY    ORGAN. 

Find   the    local  vaso-constrictor    nerves  of  the 
organ.     Stimulate  them  by  the  method  of  alternate 


113 

or  varying-  pressures.  This  will  reduce  capillary 
pressure.  Next,  see  that  the  tissues  of  the  organ 
are  relaxed;  third,  secure  drainage  by  relaxing  all 
structures  lying-  on  or  near  the  veins  which  drain 
the  org-an;  fourth,  reduce  the  pressure  g-enerally 
by  an  inhibitory  treatment  in  heart  centers,  third 
to  fifth  dorsal  and  at  the  annulus  of  Vieussens. 


HIP — DISLOCATION   OP.       (FEMUR.) 

Though  the  strongest  of  the  freely  movable 
articulations,  the  hip  is  frequently  partially  or 
.completely  dislocated.  If  the  hip  is  completely  out, 
the  g-ait  will  usually  indicate  the  condition. 

The  Osteopath  must  bear  in  mind  the  fact  that 
even  partial  or  complete  dislocation  may  be  the 
result  of  tubercular  processes.  Motion  in  such 
cases  is  a  positive  injury,  though  treatment  may  be 
effective  if  directed  toward  the  blood  and  nerve 
supply.  In  dislocation  the  ilio-femoral  ligament, 
the  most  resistant  portion  of  the  capsular,  deter- 
mines largely  the  position  of  jthe  hip. 

To  detect  dislocation  the  patient  should  be  lying- 
straig-ht,  face  upward;  place  the  thumbs  on  the 
anterior  superior  spines  of  the  ilia.  A  comparison 
of  the  two  sides  is  usually  the  surest  way  of  deter- 
mining relative  positions  of  the  parts.  Nelaton's 
line  is  useful.  It  is  a  line]  from  the  anterior 
superior  spine  to  the  tuberosity  ischii.  On  this 
line  lies  the  center  of  the  acetabulum  and  at  the 


114 

same  level  as  the  trochanter  major.  The  femur 
may  be  dislocated  in  any  direction;  backward, 
either  above  the  dorsum  ilii,  or  below  the  obturator 
internus  muscle  into  the  sacro-sciatic  notch,  or  it 
may  be  anterior  on  the  pubes  or  inferior  into  the 
obturator  or  thyroid  foramen. 

The  effect  of  the  dislocation  may  be  manifest  in 
the  gait,  muscular  condition  of  the  limb,  pain  at 
hip  or  at  knee,  and  in  the  condition  of  the  blood 
vessels  of  the  limb;  these  various  tissues  may  be 
affected  in  various  ways.  Venous  stasis,  neuritis 
and  muscular  atrophy  are  very  common  sequelae 
of  femoral  dislocation. 

To  set  a  dislocated  femur,  have  the  patient  lie  on 
his  side  on  a  low  table  or  couch  with  his  dislocated 
hip  upward.  Flex  both  leg's.  With  one  arm  clasp 
his  leg  at  knee  and  with  the  other  hand  on  the  tro- 
chanter the  hip  may  be  turned  into  place.  Patient 
may  sit  on  stool  and  the  physician  sits  on  the  knee 
of  sound  limb.  Now  take  hold  of  ankle  and  tro- 
chanter, as  above,  and  turn  into  place.  Either  of 

PLATE  26. 

Setting  an  Atlas,  The  neck  must  be  thoroughly  relaxed. 
The  thumbs  rest  on  the  transverse  process  of  the  atlas,  just 
back  of  the  angle  of  the  jaw,  the  fingers  resting  on  the 
occiput.  The  head  is  then  forced  backward  strongly  by 
pressure  exerted  on  the  side  of  the  head  with  the  palms' 
Now  the  motion  is  just  reversed  and  the  head  flexed  as  far 
forward  as  possible,  the  corrective  pressure  being  put  on 
the  atlas  at  this  time.  In  case  one  side  is  more  anterior 
than  the  other,  the  pressure  must  be  regulated  to  suit  the 
condition.  Do  not  try  this  movement  more  than  once  each 
treatment  as  irritation  maybe  produced.  In  case  the  atlas 
is  lateral  it  may  be  set  by  the  method  shown  in  Plate  24,  q.  v. 


PLATE  26. 


116 

these  positions  relaxes  the  tissues  and  makes  the 
work  much  easier. 


HYSTERIA. 

Find  if  possible  the  cause.  Local  examinations 
for  pelvic  troubles  may  be  necessary.  In  many 
cases  the  cause  seems  to  be  a  reflex,  the  deep 
muscles  of  the  back  being-  contracted.  In  such  a 
case  a  strong-  extension  followed  by  quieting1  treat- 
ment along-  the  spine  is  indicated.  A  turned  rib 
may  be  the  causa  can  sans.  Avoid  all  stimulants. 
Use  nourishing-  and  easily  digested  food.  Be 
master  of  your  patient.  Suggestion  is,  in  such 
cases,  a  most  valuable  aid.  A  gentle  downward 
stroking  of  the  spine  will  produce  sleep. 

A  cool  bath  each  morning  aids  the  circulation; 
the  rest  cure  is  some  times  productive  of  good.  At 
other  times  a  shock  or  a  scolding  will  produce  a 
change. 

Pressure  in  the  sub-occipital  region  or  on  the 
ganglia  of  the  cervical  sympathetic  will  stop  the 
muscular  spasms.  No  two  cases  can  be  treated 
alike. 


ICTERUS — JAUNDICE. 

This  is  a  symptom  of  many  diseases.  The  one 
constant  condition  is  obstruction  of  the  biliary 
ducts. 

Treatment.     Vibrate  the  liver,  the  patient  lying 


117 

on  left  side  or  on  back.  Press  upward  beneath 
seventh  to  tenth  cartilages  on  right  side.  Knead 
the  bowels.  Open  bowels  thoroug-hly ;  relax  the  mus- 
cles in  lower  dorsal  region.  Careful  examination 
will  reveal  lesion  in  the  dorsal  region  eighth  to 
tenth.  Not  infrequently  a  rib  is  pressing  upon 
the  liver.  Readily  yields  to  the  treatment.  Give 
light  diet  and  abundance  of  water. 


ILIUM-DISLOCATION    OF. 

The  pelvis  may  be  considered  as  formed  of  three 
bones,  viz.,  the  sacrum  and  the  two  innominates. 
Of  course  the  sacrum  articulates  with  the  last  lum- 
bar vertebra  above  and  the  coccyx  below,  but  these 
may  be  treated  as  vertebral  articulations. 

This  will  then  give  us  three  points  for  disloca- 
tions— at  the  sacro-iliac  synchondroses  and  at  the 
pubic  symphysis. 

Causes  may  be  varied.  The  most  common  are 
sudden  jars,  strains  in  rowing  or  lifting,  falls,  and 
childbirth. 

The  condition  may  be  that  of  both  innominates 
tipped  either  forward  or  backward,  giving  the 
patient  a  peculiar  gait,  halting  step  and  a  constant 
fear  of  falling;  or  one  innominate  may  be  slipped 
either  upward  or  downward,  the  other  remaining 
in  its  true  position.  In  this  case  there  will  be  a 
marked  slip  at  the  symphysis  pubis  accompanied 
by  exalted  sensitiveness. 


118 

These  conditions  affect  the  cutaneous  sensations 
and  muscular  condition  of  lower  limbs.  They  are 
also  accompanied  by  neuritis,  rheumatism,  sciatica 
and  circulatory  disturbances.  They  frequently 
produce  a  direct  effect  on  the  condition  of  all  the 
pelvic  orguns,  including-  the  rectum  and  its  sphinc- 
ters. 

To  correct  a  forward  innominate,  the  iliac  crest 
and  the  tuberosity  ischii  offer  points  for  obtaining- 
leverag-e,  the  patient  lying-  on  his  side.  Force,  by 
a  rotary  motion,  the  crest  backward  and  the  tuber- 
osity forward  and  the  work  is  done.  The  reverse 
motion  will  replace  a  backward  slip  of  the  innom- 
inate; or,  it  may  be  done  as  in  plate  27. 

Should  both  innominates  be  tipped  backward, 
they  may  be  corrected  by  placing-  the  patient  on 
his  face,  placing-  solid  yet  soft  padding-  beneath  the^ 
pelvis  so  as  to  support  the  lumbo-sacral  portion  of 
the  spine.  Now  place  one  hand  on  the  sacrum  and 
with  the  other  arm  draw  upon  the  thig-hs  so  as  to 
straig-hten  the  body  and  at  the  same  time  stretch 
the  lower  spinal  region.  A  series  of  treatments  of 
this  kind  will  correct  the  condition  and  relieve  the 
various  symptoms  mentioned. 

PLATE  27. 

Setting  a  Sacro-Iliac  Slip.  As  shown  in  plate,  the  ilium 
is  slipped  backward.  The  patient  must  be  prepared  by  a 
few  treatments  to  produce  thorough  relaxation.  He  then 
lies  face  downward  on  table.  The  physician  presses  with 
the  heel  of  the  hand  on  sacrum,  and  opposite  ilium,  while 
with  the  other  hand  he  forces  the  leg  on  the  side  of  the 
slipped  ilium  backward  as  shown.  When  the  limit  of  back- 
ward extension  is  reached,  then  a  sudden,  strong,  yet 
limited  pressure  produces  the  correction  desired. 


120 

INCONTINENCE    OF    URINE. 

Examine  for  preputial  adhesions  or  for  irrita- 
tion to  the  clitoris.  In  many  cases  relieving-  the 
trouble  at  these  points  is  all  that  is  necessary. 
The  spinal  lesion  is  found  in  the  second  to  fourth 
lumbar,  and  irritation  in  the  sacral  region. 

Treatment.  Place  the  patient  face  downward. 
Put  one  hand  in  upper  lumbar  region  and  with  the 
other  make  strong-  traction  of  leg's.  Then  place 
the  hand  firmly  on  third  lumbar  vertebra  and  move 
the  leg's  from  side  to  side  bending-  the  body  at  the 
middle  lumbar  region.  Then  lay  patient  on  side 
facing-  you.  Flex  the  legs  and  place  them  against 
your  body  reaching-  over  with  one  hand  and  press- 
ing against  the  vertebra  that  is  affected.  Now, 
again  place  the  patient  on  face  and  beginning  at 
lower  dorsal  region  press  strongly  upward  and  out- 
ward opposite  each  spine  successively  till  you  have 
reached  the  coccyx.  A  complete  cure  will  result. 


INFANTILE   PARALYSIS. 

The  osteopath  is  usually  called  to  these  cases 
several  years  after  the  condition  first  came  on. 
Much  can  be  done  to  restore  use  to  the  limb,  yet 
the  progress  must  be  slow.  Lesion  is  usually  in 
the  cervical  or  lumbar  region,  though  it  may  be  at 
any  point.  Thorough  spinal  extension  is  always 
indicated.  Manipulation  of  the  nerves  to  the  paral- 
ized  member  is  necessary. 


121 

Prognosis.  Complete  recovery  is  rare.  No 
promise  can  be  made  as  to  time.  Little  can  be 
expected  in  less  than  six  months,  while  two  or 
three  years  may  be  required  in  some  instances. 

INFLUENZA — LA  GRIPPE,  GRIPPE. 

Put  patient  to  bed.  Strong-  and  steady  treat- 
ment along-  the  spine  from  occiput  to  sacrum. 
The  fever  must  be  controlled  by  holding-  the  sub- 
occipital  region  and  by  steady  pressure  at  the 
inferior  cervical  g-ang-lion.  Use  a  spong-e  bath. 
Relieve  the  headache  by  g-ently  treating-  the  fifth 
nerve,  pressing-  steadily  one  hand  on  occiput  and  one 
on  forehead;  also  press  the  temples  between  the 
palms,  etc.  A  hot  lemonade  and  a  good  sweat  must 
be  given.  Do  not  allow  patient  to  g-et  up  too  soon. 
Use  little  food.  Treat  two  or  three  times  per  day. 
Of  hundreds  of  cases  of  La  Grippe  treated  osteo- 
pathically,  scarcely  a  case  has  had  a  bad  sequela. 


INSANITY. 

In  many  cases  a  definite  spinal  lesion  will  be 
found,  usually  in  the  cervical  region.  In  some 
cases  where  there  seems  to  be  only  deep  contrac- 
tions, the  relaxation  from  the  treatment  relieves 
nervous  irritation  and  effects  a  cure.  In  others 
the  treatment  is  ineffective.  The  causes  may  be 
various. 

Prognosis.      Will  depend  on  the  case  and   the 


122 

result  of  the  examination.     As  a  usual  thing-  it  is 
not  favorable. 


INSOMNIA. 

In  this  condition  there  is  usually  a  marked  con- 
traction of  the  muscles  in  the  cervical  and  upper 
dorsal  region.  In  females  it  may  be  from  pelvic 
diseases.  Relaxation  is  the  key  to  the  cure.  There 
will  usually  be  found  one  or  more  osseous  lesions 
in  the  upper  spinal  segments.  Correction  of  these, 
accompanied  by  a  thoroug-h  inhibition  along-  the 
spine  will  be  effective.  Have  patient  cultivate 
deep  breathing-  and  holding-  breath  as  long-  as  pos- 
sible. Outdoor  exercise,  lig-ht  diet,  sleeping-  in 
room  alone  and  g-ymnastics  will  aid  in  the  cure. 
Warm  water  drunk  freely,  or  a  g-lass  of  hot  milk, 
at  bed  time,  will  produce  g-ood  effects.  Setting- 
every  muscle  in  the  body  with  a  forcible  contraction 
will  be  followed  by  complete  relaxation  and  sleep. 

PLATE  28. 

To  Correct  an  Ante r  or  Upper  Dorsal.  Patient  sits  on 
stool  with  hands  locked.  The  physician  stands  behind  and 
passing  his  arms  beneath  those  of  the  patient,  clasps  the 
wrists  of  the  latter.  Now  drawing  the  patient  back  against 
his  knee,  which  must  be  against  the  vertebra  next  below  the 
one  to  be  set,  the  physician  pulls  downward  first  with  one 
hand  then  with  the  other.  This  throws  great  tension  on  the 
vertebral  ligaments  at  the  point  where  the  knee  supports  the 
spine.  A  few  treatments  of  this  kind  will  make  a  marked 
difference  in  the  position  of  the  vertebra  as  the  ligamentous 
tension  slips  it  gradually  into  its  proper  place.  Heart, 
stomach,  lungs  or  vaso-motors  may  be  affected  by  an 
anterior  vertebra. 


124 

Prognosis.     Good.     These    means  will  always 
cure  if  persisted  in. 


KIDNEY. 

To  treat  the  kidney,  the  patient  is  placed  on  his 
side  facing-  the  physician.  The  lumbar  spine  may 
be  relaxed  by  placing-  one  hand  on  crest  of  ilium 
and  the  other  on  thoracic  wall  or  shoulder  and  giv- 
ing- a  bias  stretch,  pulling-  forward  on  ilium  and 
backward  on  ribs,  and  vice  versa.  Then  reaching- 
below  the  patient  lift  the  body  clear  of  table,  the 
hand  being  beneath  the  lumbar  vertebra.  This 
will  relax  the  quadratus  lumborum  muscle  and  also 
move  the  abdominal  viscera,  releasing-  pressure 
from  the  kidney,  its  veins  and  lymphatics.  The 
patient  is  now  placed  on  his  back,  his  legs  and 
thig-hs  flexed.  Place  the  hand  beneath  the  dorso- 
lumbar  region,  palms  up,  passing-  one  arm  over  the 
patient.  Now  elevate  the  patient  on  fing-er  tips. 
Manipulate  the  patient  over  the  kidneys  anteriorly. 

Flex  the  leg's  and  then  separate  the  knees,  the 
patient  both  passive  and  also  resistant.  Rotate  the 
leg-  outward  as  far  as  possible  to  put  traction  on  the 
psoas  muscle.  The  lesion  is  usually  found  at  the 
eleventh  dorsal  to  the  second  lumbar.  This  must 
be  corrected  according-  to  its  nature.  The  g-enu- 
pectoral  position  affords  a  convenient  position  for 
taking-  pressure  from  kidney  structures. 

Diet.     Varies  according-  to  nature  of  the  disease. 


125 

In  nephritis  avoid  nitrogenous  foods  and  use  abun- 
dance of  broths,  skim  milk  and  water. 

KYPHOSIS. 

The  lesion  is  evident.  If  there  is  tubercular 
process  use  care  in  movements. 

Treatment,  Thoroughly  relax  muscles  along 
spine  by  pressure  upward  and  outward.  Next 
thoroughly  extend  patient  by  stretching  on  the 
table,  or  seat  patient  on  a  stool  and  stand  in  front 
of  him,  his  hands  clasped  back  of  his  head;  then 
pass  arms  beneath  his  and  draw  his  upper  spine 
upward  and  forward.  This  will  relax  and  at  the 
same  time  correct  the  spine.  Another  method  is 
to  have  patient  lie  on  his  face  and  after  thoroughly 
relaxing 'him  throw  the  posterior  vertebra  forward 
by  putting  pressure  upon  them  suddenly. 


Another  method;  patient  sits  on  stool,  stand  at 
his  side,  reach  around  in  front  with  one  hand  lift- 
ing up,  and  with  the  other  hand  press  the  vertebra 
forward. 


LARYNGITIS. 

Lesion  in  cervical  vertebra  causing  disturbance 
to  sympathetic  nerve  of  larnyx  and  pharnyx.  Acute 
cases  are  often  due  to  contraction  of  the  muscles 
of  this  part  of  the  neck,  the  sterno-cleido-mastoid, 
the  scaleni,  the  infra-hyoid  and  the  supra-hyoid 
groups  of  muscles. 


126 

Treatment.  Relax  by  thorough  manipulation  the 
muscles  of  this  region.  Gently  work  over  the  ton- 
sils. Treat  internally  by  wetting1  the  finger  in 
cold  water  and  pressing-  it  over  the  hard  palate. 
The  ninth,  tenth  and  eleventh  nerves  may  be 
reached  just  below  the  lobule  of  the  ear.  This 
region  must  be  treated  thoroughly.  Acute  cases 
may  be  treated  twice  per  day.  Chronic  cases  daily 
or  every  alternate  day.  A  cold  compress  will  aid 
the  treatment. 


LEUKEMIA. 

General  relaxed  condition  of  the  spine.  Look 
for  lesions  in  the  middle  to  lower  dorsal  region. 
Tenderness  along  the  line  of  the  ninth  and  tenth 
ribs.  These  ribs  are  sometimes  turned. 

Treat  the  liver  and  spleen.  Give  general  stim- 
ulating treatment  to  the  heart.  Knead  the  abdo- 
men. Treat  the  splanchnic  nerves.  Pay  close 
attention  to  the  ribs  from  eighth  to  tenth.  The 

PLATE  29. 

Relaxing  Structures  Around  the  Saphenous  Opening, 
The  plate  shows  position,  though  both  knees  should  be 
flexed  (one  being  down  to  show  position). 

This  relaxes  Poupart's  ligament  and  the  femoral  and 
pubic  portions  of  the  fascia  which  constitute  this  open- 
ing. Pressure  (as  shown  by  thumb)  with  a  steady  rotary 
motion  will  relax  these  structures.  At  or  near  this  point  are 
reached:  the  saphenous,  femoral  and  some  superficial  veins; 
the  femoral  artery,  the  anterior  crural,  genito-crural 
branch  of  the  ilio-inguinal  and  a  cutaneous  branch  of  the 
obturator  nerve. 

This  point  is  important  in  any  affection  of  leg,  knee  or 
ankle,  varicose  veins,  cold  feet  and  related  conditions. 


128 

daily    morning-    bath,     outdoor    exercise     and     a 
nourishing-  diet  are  aids. 


LITILEMIA. 

The  liver  is  often  at  fault,  therefore  the  lesion  is 
in  region  of  eig-ht  dorsal.  Treat  the  splanchnics. 
The  kidneys  must  be  treated.  Look  carefully  to 
diet.  Amount  of  meat  should  be  small.  Raw  apples 
and  acid  fruits  of  various  kinds  are  tolerated,  but 
sweet  fruits,  starches,  etc.,  are  to  be  avoided. 


LIVER TREATMENT    OF. 

This  is  a  most  important  gland  and  should  be 
treated  in  many  diseases.  The  center  is  in  the 
splanchnics,  seventh  to  tenth  dorsal. 

Treatment,  First,  relax  in  splanchnic  region. 
Second,  have  patient  sit;  standing-  behind  him, 
reach  around  in  front  and  as  he  expels  air  after  a 
deep  inspiration,  lift  the  abdominal  wall  and 
press  up  beneath  the  eig-hth,  ninth  and  tenth 
ribs.  Third,  have  patient  lie  on  his  back  and 
thoroug-hly  knead  the  liver.  Press  inward  and  up- 
ward at  a  point  two  and  a  half  inches  above  and  to 
the  rig-ht  of  the  umbilicus.  Fourth,  have  patient 
lie  on  left  side,  and  standing  at  his  back  reach  over 
and  press  upward  on  abdomen,  just  above  umbili- 
cus; then  with  the  other  hand  vibrate  forcibly  the 
wrall  of  abdomen  lying  over  the  liver.  This  changes 
the  blood  in  the  liver  and  increases  its  activities. 


129 

Gymnastics,  outdoor  exercise  and  plenty  of  water, 
three  to  six  pints  daily,  must  be  supplementary  to 
the  treatment. 

Diet.  In  all  liver  troubles  alcohols  and  liquors 
are  forbidden.  Avoid  pork,  fried  foods,  salt  foods, 
sugars,  starches  and  oils.  Only  fresh  food  should 
be  given  and  in  reduced  quantity;  fish,  oysters, 
sweetbread,  lean  meat,  eggs,  milk,  buttermilk, 
green  vegetables,  dry  toast  and  fresh  fruit  are 
allowable.  Do  not  drink  at  meals.  Rest  an  hour 
before  and  after  eating. 


LTVER  SPOTS. 
Treatment  is  for  the  circulation  and  drainage  to 

the  particular  region  and  to  the  liver. 


LORDOSIS. 

Lesion  usually  found  in  the  lumbar  region;  oc- 
casionally in  the  dorsal  region. 

Treatment.  Relax  muscles  on  either  side.  In 
all  cases  a  strong  extension.  In  dorsal  region,  seat 
patient  on  stool,  stand  behind  and  lift  up  ribs  and 
push  them  backward  by  grasping  them  at  the 
sternal  ends  and  pulling  backwards.  The  patient 
may  be  placed  on  side  and  bent  forward,  at  the 
same  time  holding  the  spine  from  above  and  below 
so  as  to  put  the  tension  at  the  location  of  the  an- 
terior condition.  Place  the  patient  on  his  back 
and  flex  legs  and  thighs.  Place  one  hand  under 
the  vertebra  above  those  to  be  moved;  now  come 


130 

down  with  some  force  on  the  leg's.  If  this  anterior 
condition  is  in  the  upper  dorsal  region  the  same 
movement  may  be  made  with  the  neck  and  shoul- 
ders. 


LUMBAGO. 

Examine  kidneys.  Lesion  in  the  lumbar  verte- 
brae or  at  the  dorso-lumbar  or  the  lumbo-sacral  ar- 
ticulations. Sometimes  in  dorsal  region.  Look 
carefully  for  dislocations  of  the  eleventh  and  twelfth 
ribs. 

Treatment.  Nothing  better  than  stretching  the 
spine  at  this  point.  Correct  the  lesion.  Flex  the 
thighs  on  abdomen,  or,  if  patient  is  on  face,  legs 
are  vibrated  from  side  to  side.  Any  movement 
may  be  beneficial.  Do  not  neglect  the  bias  stretch, 
(q.  v.) 


LUNGS — TREATMENT    OF. 

The  one  object  in  all  treatment  is  to  secure  a 
return  to  normal  conditions.  Good  lung  circula- 

PLATE  30. 

Correcting  a  Lateral  Dorsal  Vertebra.  After  thorough 
preparatory  treatment  the  patient  lies  on  side  as  shown. 
The  physician  now  places  thumb  against  side  of  spinous 
process  and  pressing  downward  (toward  sacrum),  with  the 
heel  of  that  hand  he  pulls  upward  (toward  head),  with  the 
other  at  the  same  time  bending  the  spine  by  elevating  the 
shoulder.  This  is  a  successful  method.  Equally  good  is 
the  method  of  having  patient  sit  on  stool — process  same  as 
here. 

Patient  may  be  suspended  in  a  "swing  "  free  shoulders 
and  the  vertebra  slipped  into  place. 


132 

tion  and  regular  deep  breathing-  will  cure  any  incipi- 
ent pulmonary  trouble. 

Lesion.  In  dorsal  region  from  second  to  sixth, 
usually  a  forward  condition.  Also  any  one  of  the 
six  upper  ribs  may  be  at  fault.  Examine  carefully 
at  both  spinal  and  sternal  ends. 

Treatment.  First,  lay  patient  on  side  and  thor- 
oughly manipulate  interscapular  region.  Second, 
lay  patient  on  table,  stand  at  patient's  head  and 
placing-  one  hand  beneath  the  ang-le  of  the  ribs  take 
hold  of  arm  with  the  .other  and  draw  it  upward, 
downward,  and  then  back  to  its  position.  Now 
move  the  hand  to  the  next  rib  and  repeat.  Do  this 
for  both  sides.  An  assistant  is  valuable  here  as 
both  sides  can  be  manipulated  at  the  same  time. 
Third,  patient  lies  on  back;  stand  at  his  head,  draw 
arms  above  his  head;  the  patient  inhales  deeply; 
after  holding-  breath  as  long-  as  possible  force  the 
arms  back  to  their  normal  position.  Fourth, 
patient  sits  on  stool  and  arm  is  pulled  upward  and 
backward.  Fifth,  patient  lies  on  back.  Separate 
the  ribs  and  release  the  intercostal  nerves  by  put- 
ting- fing-ers  between  ribs  near  articulation  and 
spreading-  them. 


MEASLES. 

Avoid  exposure  to  cold.  No  osseous  lesions. 
A  secondary  lesion  in  cervical  and  upper  dorsal 
region.  Relax  these  muscles  thoroughly.  Should 


133 

the  eruption  be  imperfect,  a  thorough  stimulation 
in  the  upper  dorsal  region  will  produce  it  as  well  as 
sponging  in  tepid  water;  also  hot  drinks.  Protect 
the  eyes  from  light.  Keep  room  cool  and  well 
ventilated  and  patient  indoors;  preferably  in  bed. 
Watch  the  bronchial  tubes.  Treat  in  the  first  to 
third  dorsal  and  over  the  second  and  third  ribs 
anteriorly.  General  treatment  along-  the  spine 
with  special  treatment  for  the  fever  will  be  all  that 
is  necessary  in  worst  cases. 

MELANCHOLIA. 

Treatment  same  as  hysteria.      Change  of  sur- 
rounding's and  occupation  is  also  helpful. 


MIGRAINE. 

Lesion  may  be  in  any  part  of  spine  producing 
the  condition  as  a  reflex  from  eye,  stomach, 
hepatic,  intestinal  or  uterine  disturbances.  No 
specific  treatment  can  be  prescribed.  Correct 
these  conditions.  To  effect  a  cure  a  thorough 
course  of  treatment  is  necessary. 

Do  not  expect  to  be  successful  in  all  cases 
during-  paroxysms  of  pain.  The  treatment  must 
be  given  regularly.  During  paroxysm  give  the 
regular  headache  treatment. 


MUMPS. 

The  lesion  is  reflex,  a  contraction  in  cervical  and 
upper   dorsal  regions.      Keep  patient  warm  and 


134 

quiet.  Good  ventilation;  avoid  colds.  Relax  cervi- 
cal regions  and  especially  relieve  by  gentle  manip- 
ulation the  swollen  glands.  Care  for  eyes  and  ears 
and  the  reproductive  organs.  Keep  temperature 
down  by  usual  fever  treatment  and  do  not  permit 
patient  to  exert  himself  too  soon. 

MUSCULAR   RHEUMATISM — MYALGIA. 

Lesion  usually  in  the  lower  dorsal  region, 
embracing  the  liver  and  kidney  region;  these  organs 
are  usually  at  fault. 

Treatment.  Treat  the  liver  and  kidneys  accord- 
ing to  directions  given  under  head  of  those  organs. 
Treat  the  upper  dorsal  and  cervical  regions  for 
affections  in  the  arms,  and  the  lumbar  and  sacral 
regions  for  the  legs.  Relax  the  muscles  and  follow 
the  nerves  from  their  exit  to  the  part  affected, 
putting  steady  pressure  on  them.  Thoroughly 
relax  the  spinal  musculature.  Treat  gently  once 
or  twice  per  day.  Hot  fomentations  often  give 
relief. 

PLATE  31. 

Stretching  the  Pyriformis  Muscle.  The  plate  shows  the 
process.  B}T  giving  a  strong  external  rotation  to  the  thigh 
and  at  the  same  time  putting  deep  and  strong  pressure  upon 
the  pyriformis  muscle  it  relieves  it  from  tension  and  thus 
directly  affects  the  rectum,  sacral  plexus,  the  internal  iliac 
vessels,  the  sciatic  nerve  and  the  internal  pudic  vessels  and 
nerve. 

The  importance  of  freeing  this  muscle  from  contraction 
cannot  be  too  strongly  emphasized  in  all  troubles  to  the 
lower  limb.  It  is  also  related  to  the  condition  of  the  genital 
organs,  though  not  so  directly. 


136 

Diet.  Cereals,  broths  and  lig-ht  meats.  Avoid 
meats  in  excess,  sug-ars  and  starches.  Drink  hot 
water  in  abundance. 


MYOCARDITIS. 

Lesion  in  upper  dorsal  region  and  in  ribs. 

Treatment.  Separate  and  set  the  ribs.  Treat 
the  vaso-motors  to  lung-s  and  heart.  Relax  all  con- 
tractures  in  upper  dorsal  region.  Outdoor  air  and 
exercise  are  helpful.  Diet,  lig-ht  and  strengthening-. 


NEPHRITIS. 

Lesion  in  the  lower  dorsal  and  upper  lumbar. 
Correct  this.  (See  kidneys.)  Watch  the  urine  very 
carefully. 

Diet.  Avoid  all  proteids,  meats,  heavy  foods, 
etc.  Meals  should  be  lig-ht  and  consist  chiefly  of 
milk,  buttermilk,  gruel,  broths.  Should  symptoms 
abate,  eg-g-s,  meat-broths,  etc.,  may  be  allowed. 
Diet  is  of  utmost  importance. 

NEURALGIA. 

Find  the  nerve  affected  and  release  the  pressure, 
removing-  the  irritation.  To  do  this,  usually  it 
is  only  necessary  to  trace  the  affected  nerve  to  the 
spine  and  release  it  near  its  exit. 

Intercostal  type^  Either  raise  the  rib  or  set  the 
vertebra  which  is  causing-  the  trouble. 

Cardiac  t\pe.  Usually  the  trouble  is  in  the  third, 
fourth  or  fifth  rib.  Raise  and  separate  these  and 


137 

put  steady  pressure  at  their  ang-les  or  near  spine. 
Hot  fomentations  are  useful. 

Gastric  Type.  Trouble  is  usually  in  the  inter- 
costal nerves.  Sometimes  it  is  reflex  from  uterine 
troubles.  Look  for  lesion  in  sixth  to  eighth  ribs; 
sometimes  it  is  higher  and  with  the  vertebrae. 
Steady  pressure  is  always  able  to  give  relief.  It  is 
often  difficult  to  restrain  patient  from  taking-  mor- 
phine, but  if  the  treatment  is  persisted  in  relief 
will  follow.  Corrective  treatment  must  be  admin- 
istered between  the  attacks. 

Facial  Neuralgia.  Frequently  due  to  decayed 
teeth;  also,  often  from  dislocated  axis  or  atlas. 
Treat  the  various  terminal  branches  of  the  fifth 
nerve.  Correct  the  lesion  in  the  cervical  region. 


NEURASTHENIA. 

Lesion.  Not  in  any  definite  point.  It  is  a  nervous 
irritation.  Examine  as  to  condition  of  sexual 
organs.  The  liver  is  often  at  fault.  Lithemia  is 
a  common  condition.  Deep  spinal  contractures 
are  always  present. 

Treatment.  Stimulate  the  liver.  Relax  the  mus- 
cles of  spine  in  upper  dorsal  and  cervical  regions. 
Stimulate  the  heart.  Manipulate  the  neck  for 
drainage  of  head.  A  g-eneral  treatment  is  indi- 
cated. A  treatment  just  at  bed  time  will  often 
insure  a  night's  rest.  No  two  cases  can  be  treated 
alike. 


138 

NEUROSES — OCCUPATION    NEUROSES. 

Lesion  is  always  in  the  spine  near  exit  of 
affected  nerve,  or  else  at  vaso-motors  to  the  nerve. 
For  the  arms  it  is  in  cervical  reg-ion  second  to 
seventh,  or  else  in  the  upper  dorsal.  In  many  cases 
it  is  simply  long-  standing1  contractures. 

Treatment.  Thoroug-hly  relax  these  regions  and 
correct  any  lesions  present.  Manipulation  of  the 
structures  lying-  along-  the  course  of  the  affected 
nerve  will  aid  in  its  recovery.  A  chang-e  of  occu- 
pation is  indicated.  Prognosis  is  good. 
I  

NEUROSKS,    TRAUMATIC. 

In  these  conditions  there  is  a  tightening-  of  all 
the  contractile  substances  along  the  spine  includ- 
ing deep  muscles  and  ligaments. 

Treatment.  A  thorough  relaxation  of  every  ver- 
tebral articulation,  followed  by  a  stimulation  to  the 
nerves  of  the  superficial  spinal  region. 

PLATE  32. 

Turning  a  Rib  Upward.  Plate  shows  the  process.  The 
thumb  presses  between  the  depressed  rib  and  the  one  next 
below,  between  the  angle  and  its  costo-transverse  articula- 
tion. The  arm  is  drawn  strongly  as  shown  in  plate.  Then 
the  arm  is  pulled  upward  and  backward  and  there  released, 
the  thumb  still  pressing-  as  before.  The  first  part  of  the 
motion  separates  the  ribs  posteriorly,  while  the  latter  part 
pulls  them  upward  and  apart  anteriorly  by  means  of  the 
pectorales  muscles,  the  pressure  of  the  thumb  then  forcing 
the  depressed  one  into  its  proper  place. 


140 

NEURITIS. 

Lesion  oftimes  from  dislocation  or  luxation  of 
vertebra  in  the  upper  dorsal  region.  The  nerve 
affected  will  point  the  lesion. 

Treatment.  Rest  in  bed.  Relax  the  entire  spine. 
Gently  massage  the  structures  surrounding-  the 
nerve  affected.  Hot  applications  will  aid  in  drain- 
age and  in  reducing-  the  pain.  Diet  should  be  nour- 
ishing- and  easily  assimilated. 


OBESITY. 

Diet,  exercise  and  gymnastics  are  all  that  can  be 
done  in  this  condition. 

OBSTETRICS. 

It  is  safe  to  assume  that  a  woman  apparently  well 
formed  will  come  safely  throug-h  childbirth,  so  it  is 
not  necessary  to  examine  the  pelvis  unless  there  is 
a  deformity  or  a  rachitic  history.  But  there  are 
certain  precautions  which  every  woman  should 
take  during-  preg-nancy.  Diet  of  fruits  and  cereals, 
outdoor  exercise  and  baths  are  conducive  to  an 
easy  delivery  and  a  perfect  child. 

When  called,  the  physician  should  carry  with  him 
a  cool  head  and  willing-  hands.  In  addition  he 
should  have  a  case  containing-  tablets  of  mercury 
bichloride,  shears,  surg-eons'  cotton,  a  roll  of  clean 
muslin,  a  spong-e  and  a  spool  of  silk  thread. 

Uncleanliness  and  untidiness  in  a  case  of   this 


141 

kind  is  a  crime.  The  expectant  mother  should  first 
be  g-iven  a  sitz  bath,  carefully  cleansing-  the  perin- 
eeum.  Then  the  hand  of  the  operator,  after  a  thor- 
ough scrubbing-  with  soap  and  water,  should  be 
held  in  a  bichloride  solution,  1  to  1,000,  for  a  few 
minutes,  and  then  an  examination  of  the  patient 
should  be  made.  The  hand  should  be  thoroughly 
cleansed  and  rendered  aseptic  previous  to  each 
examination.  This  must  never  be  disregarded. 

The  bed  should  be  prepared  by  placing-  either 
oilcloth,  rubber  or  a  layer  of  newspapers  beneath 
the  sheet.  The  perinaeum  and  vagina  should  be 
thoroug-hly  relaxed.  Pressure  upon  and  manipu- 
lations of  the  perineal  body  will  produce  a  very 
satisfactory  result.  The  dilatation  of  the  os  may  be 
very  much  hastened  by  passing-  the  fing-er,  thor- 
oug-hly aseptic,  around  the  edg-e  of  the  os,  also  by 
pressure  on  clitoris  and  on  round  lig-aments.  This 
will  lessen  pain.  To  reduce  the  pain,  press  on 
either  side  of  the  spine  in  the  lumbar  region,  fourth 
and  fifth,  and  in  the  eig-hth  to  tenth  dorsal;  this  does 
not  retard  the  progress  of  the  case.  Should  the 
pains  and  the  expulsive  movements  of  the  uterus 
become  tardy,  stimulation  in  the  lumbar  region 
may  be  effective.  Relaxation  of  the  round  lig-a- 
ments as  they  pass  over  the  pubic  crest  will  allow 
the  uterus  to  protrude  further  into  the  canal  of  the 
vagina.  Steady  pressure  at  the  symphysis  pubis 
will  also  aid  in  relaxation  of  the  parts  and  reduction 
of  pain. 


142 

Should  the  child  be  large  and  the  labor  difficult, 
it  is  well  to  guard  the  perinaeum  by  holding-  the 
hand  against  the  perineal  body,  thus  guiding-  the 
infant  throug-h  the  vag-inal  opening-.  Push  the  tis- 
sues from  the  symphysis  toward  the  perineal  body. 

As  sooih  as  the  head  is  born  examine  to  see  if  the 
cord  be  around  the  neck.  If  so,  loosen  and  follow 
it  with  the  fingers,  one  on  either  side,  within  the 
vagina  to  protect  it  from  occlusion.  In  foot  pre- 
sentation, the  body  should  be  wrapped  in  cloth  or 
cotton  to  protect  from  the  air  until  the  head  is  born. 
The  cool  air  against  the  skin  may  stimulate  the 
respiratory  center,  causing  the  child  to  breathe. 

As  soon  as  the  child  is  born,  open  its  mouth, 
cleanse  the  mucous  passages  until  it  has  given  a 
good  cry,  then  keep  it  covered  and  wait  until  the 
pulsations  have  ceased  in  the  umbilical  cord.  Now 
draw  the  cord  between  the  thumb  and  finger  to- 
ward the  umbilicus  and  tie  with  a  clean  thread 
about  two  inches  from  the  infant's  navel,  and  snip 
the  cord  just  outside  this  point. 

If  the  placenta  has  not  yet  been  delivered,  gentle 
traction  on  the  cord  may  produce  it.  The  mother 
can  usually  assist  by  an  expulsive  movement,  as 
coughing  or  blowing  into  the  closed  hand.  There 
is  no  need  to  hurry  in  this  matter;  an  hour  may 
sometimes  elapse  before  the  placenta  is  passed.  In 
case  it  is  not  easily  secured,  pressure  on  the  abdom- 
inal wall  above  the  pelvis  may  secure  it.  Place 


143 

the  palms  flat  upon  the  walls  and  press  forcibly 
downward.  Do  not  insert  the  hand  into  the  uterus 
unless  absolutely  necessary.  If  the  hand  is  in- 
serted, be  sure  that  it  is  aseptic.  Pass  the  fingers 
between  placenta  and  the  uterine  wall,  and  the  air 
entering1  will  often  release  it.  If  this  is  not  suffi- 
cient, gently  force  it  from  the  wall  of  the  uterus. 

After  the  delivery,  if  there  has  been  no  lacera- 
tion and  no  cause  to  suspect  infection,  the  external 
genitals  should  be  carefully  cleansed,  the  vulva 
protected  by  a  cloth  fastened  as  the  napkins  are 
usually  fastened.  Between  the  napkin  and  the 
vulva  should  be  a  pad  of  surgeon's  cotton.  Should 
there  be  post-partum  hemorrhage  it  can  be  checked 
by  stroking  sharply,  with  the  cold  hand,  the  mons 
veneris. 

The  uterus  must  be  reduced  to  contract  the  ves- 
sels and  close  the  sinuses.  This  is  done  by  gently 
manipulating  the  fundus  throug-h  the  abdominal 
wall.  This  will  reduce  the  intensity  and  the  num- 
ber of  the  afterpains  and  shorten  the  lying-in 
period  and  prevent  hemorrhage. 

The  mother  should,  after  being  made  scrupu- 
lously clean,  be  left  to  sleep.  Rest  is  the  great  re- 
storer. The  nurse  should  be  instructed  to  care- 
fully cleanse  the  external  g-enitals  with  soap  and 
water,  following  with  a  solution  of  bichloride  of 
mercury,  1  to  2,000.  Should  it  be  deemed  neces- 
sary to  use  an  injection,  a  perfectly  sterile  pipe  must 


144 

be  used,  having-  been  dipped  in  boiling-  water,  and 
both  tube  and  pipe  having-  been  left  in  a  bichloride 
solution  of  1  to  1,000  for  ten  minutes.  The  injec- 
tion may  be  1  to  4,000  bichloride,  or  creolin  1  to  100 

(1%). 

The  nurse  should  be  given  explicit  directions  as 
to  the  care  of  the  patient.  The  breasts  should  be 
watched  carefully.  A  scanty  secretion  of  milk  may 
be  increased  by  a  separation  of  the  upper  five  or 
six  ribs,  lifting-  scapula,  and  freeing  the  subclavian 
and  axillary  arteries.  This  affects  the  internal 
mammary  branches  \vhich  supply  the  mammary 
g-land.  It  also  stimulates  the  intercostal  nerves  in 
this  region.  We  spread  the  ribs,  increasing-  the 
blood  supply  throug-h  perforating  arteries,  and  giv- 
ing- a  perfect  drainage  through  the  veins.  The  in- 
ternal mammary  artery  may  be  reached  at  its 
origin  from  the  subclavian,  producing  effect 
through  the  plexus  derived  from  the  subclavian, 
and  from  the  inferior  cervical  g-anglion.  Let  me 
repeat  that  the  introduction  of  the  hand  into  the 
uterus  to  take  the  placenta  is  the  most  dangerous 
part  of  childbirth.  It  should  be  done  only  as  a  last 
resort. 


PALPITATION. 

See  cardiac  troubles  for  treatment  of  heart. 
Press  upon  the  inferior  cervical  ganglion,  raise  the 
ribs  to  overcome  this  condition.  Press  upon  the 
solar  plexus. 


145 

PANCREAS TREATMENT    OF. 

Lesions  affecting-  this  gland  are  in  the  splanchnic 
area.  The  solar  plexus  affords  the  means  of 
reaching-  it  anteriorly.  Treatment  should  be 
directed  to  ninth  and  tenth  ribs  and  vertebra. 

PARALYSIS. 

Lesions.  First,  cerebral  hemorrhage.  Second, 
in  cervical  regions,  atlas  and  axis.  Third,  in  the 
upper  dorsal  region,  and.  fourth,  Jess  often  in  cases  of 
paraplegia  in  the  lower  dorsal  and  lumbar  regions. 

Treatment.  The  various  organs,  as  stomach,  in- 
testines and  kidneys,  must  be  carefully  watched 
that  proper  nutrition  and  excretion  may  be  per- 
formed. Give  a  general  treatment,  but  treat  spe- 
cifically to  correct  the  lesion.  In  case  there  is 
cerebral  lesion  the  cervical  region  should  have  the 
most  careful  attention.  Relaxation  and  a  soothing- 
spinal  treatment  will  overcome  sleeplessness. 
Manipulate  each  joint  should  there  be  tendency 
toward  anchylosis. 

Prognosis.  Almost  always  an  aid  toward  recov- 
ery, thoug-h  complete  recovery  is  the  exception. 


PAROTITIS MUMPS 

Lesion.  Contraction  of  muscles  of  cervical  region 
both  anteriorly,  laterally  and  posteriorly.  Treat- 
ment consists  in  g-entle  manipulation  of  these. 
Treatment  around  the  enlarged  giands  will  reduce 


146 

the  inflammation.  Rest  in  bed  and  either  hot  or 
cold  applications  to  the  swollen  glands  will  be  help- 
ful. In  case  of  orchitis,  rest  and  a  support  tog-ether 
with  g-entle  manipulation  around  the  external  ab- 
dominal ring- will  be  sufficient.  Treatment  in  lum- 
bar region  will  aid  orchitic  complications. 


PERICARDITIS. 

For  osteopathic  treatment  of,  see  Cardiac  Trou- 
bles. 


PERITONITIS. 

Lesion.  Muscular  contraction  in  the  splanchnic 
and  lumbar  regions.  Usually  osseous  lesions  in 
lumbar  region. 

Treatment  consists  in  opening-  the  bowels  by 
enemas  of  soap-suds,  if  necessary.  Relaxation  in 
the  regions  named  above.  Gentle  manipulation  and 
pressure  over  the  'areas  of  solar  and  inferior  mes- 
enteric  plexuses.  Hot  bath  with  quiet  abdominal 
manipulation  will  usually  avert  an  attack.  Hot 
fomentations  are  invaluable.  Diet  should  be  liquid 
or  semi-solids;  raw  eg-g-s  and  milk  beaten  tog-ether, 
or  eg-g-s  and  wine,  custards,  broths,  gruel,  etc., 
should  be  the  diet  until  symptoms  have  subsided. 
Treatment  should  be  given  as  often  as  pain  returns. 


PERTUSSIS — WHOOPING    COUGH. 

Lesion.     Is  always  reflex,  no  constant  osseous 
lesion.     All  muscles  of  throat  and  neck  cong-ested, 


147 

the  contraction  extending-  down  to  mid-dorsal 
region.  Examine  scaleni  affecting-  first  and  sec- 
ond ribs. 

Treatment.  Remove  pressure  from  laryng-eal 
filaments  of  tenth  nerve  by  relaxing-  muscles  of 
neck.  Remove  disturbance  to  the  vaso-motors  of 
the  lung-s  in  the  upper  dorsal  region.  Correct  the 
upper  two  ribs  and  relax  the  muscles  in  the  deeper 
layers  at  the  heads  of  these  ribs. 

Prognosis.  If  treated  at  beginning-,  the  disease 
may  be  aborted.  Paroxysms  may  be  stopped  by 
pressure  at  the  second  and  third  dorsal  vertebrae. 


PHARYNGITIS. 

Lesion.  In  cervical  region;  either  muscular  or 
osseoas,  or  both. 

Treatment.  Stimulate  the  superior  cervical  sym- 
pathetic after  having-  thoroug-hly  relaxed  all  the 
muscles  of  the  infra-hyoid  and  lateral  muscles. 
Reach  the  ninth  nerve  just  below  the  lobule  of  the 
ear.  The  tenth  may  be  reached  here  or  in  the 
sheath  of  the  carotid  artery.  Treatment  internally 
with  fiiig-er  over  the  mucous  membrane  of  tonsils 
and  pharynx  reduces  inflammation.  A  cold  com- 
press from  ice  water  is  g-ood. 


PILES — SEE   HAEMORRHOIDS. 


PLEURISY. 

Lesion.     Invariably  found  in  the  dorsal  region. 


148 

The  ribs  on  the  affected   side  are  usually  down. 
The  location  of  the  pain  will  indicate  the  lesion. 

Treatment.  Raise  the  rib,  stretch  the  inter- 
costal muscles.  Give  steady  pressure  on  the 
affected  nerves  at  their  exit  from  the  spine.  The 
usual  lung-  treatment  may  be  given.  Perhaps  an 
hour  may  be  required  to  control  the  pain. 

Prognosis.     Is  very  favorable. 

Diet.  In  the  form  of  pleurisy  with  effusion,  the 
diet  should  consist  of  very  lean  meat  and  stale 
bread,  with  as  little  fluid  as  will  allay  thirst.  Ice 
may  be  sucked  to  avoid  drinking-  much  fluid. 


PNEUMONIA. 

Lesion.  In  the  dorsal  region  from  second  to 
sixth  vertebrae.  The  intercostal  muscles  are  all 
contracted. 

Treatment.  Relax  the  muscles  in  the  upper 
dorsal  region.  Use  arm  as  a  lever,  put  one  hand 
between  spine  and  scapulae  and  force  arm  and 
scapula  backward.  This  will  relax  the  levator 
angili  scapulae,  the  rhomboids,  and  the  continu- 
ations of  the  erector  spinae.  Thoroughly  relax  all 
the  muscles  along-  the  spine  by  pressing-  upward 
and  outward.  Manipulate  anteriorly.  Overcome 
sleeplessness  by  gently  manipulating-  the  spine 
downward  and  by  treating-  filaments  of  fifth 
nerve.  Bowels  are  to  be  kept  reg-ular  by  kneading-. 
Stop  coughing-  by  pressing  with  thumb  at  third  and 


149 

fifth  dorsal.  Pain  can  be  relieved  by  pressure  at 
certain  point;  examination  will  reveal  it.  Pyrexia 
controlled  at  sub-occipital  region  and  first  rib  by 
steady  pressure.  Sponging'  with  cool  or  tepid 
water  will  regulate  temperature.  This  must  be 
done  daily. 

Diet.  Milk,  custard,  broths,  fruit  juice,  etc., 
every  two  or  three  hours.  Even  after  deferves- 
cence the  return  to  solid  diet  must  be  very  gradual. 


POLYURIA. 

Lesion.  In  the  dorso-lumbar  region.  Examine 
tenth,  eleventh  and  twelfth  ribs. 

Treatment.  Correct  lesion.  Relax  quadratus 
lumborum  muscle.  Spring-  the  spine  forward  in 
case  of  kyphosis,  frequently  a  lateral  trouble. 
Treat  as  a  kidney  lesion. 

Prognosis.  Recovery  is  usually  accomplished  by 
this  treatment. 

POTTS    DISEASE. 

Lesion.  Is  evident.  Treatment  is  wholly  correc- 
tive and  to  relax  the  muscles  along-  the  spine  thus 
affecting-  drainag-e.  In  case  the  disease  is  well 
marked,  care  must  be  used  to  avoid  violence.  A 
swing-  is  necessary  to  suspend  the  patient  from  his 
arms,  thus  relieving  the  pressure  on  the  spine.  No 
violent  treatment  should  be  given. 

Prognosis.  In  advanced  cases  the  prognosis  is 
very  poor.  In  early  stag-es  it  is  hopeful.1 


150 

PYELITIS- 

Treatment   for   pyelitis   does  not  differ  in  any 
marked  respect  from  that  of  nephritis. 


QUINSY — SEK    TONSILLITIS. 


RACHITIS. 

Lesion.     In  spinal  region  at  various  levels. 

Treatment.  Stimulate  the  nerves  to  the  digest- 
ive  organs;  particular  attention  to  the  splanchnics. 
Correct  any  lesions.  Diet  and  hygiene  are  impor- 
tant. Special  treatment,  with  exercise,  baths. 
gymnastics  and  the  following1  diet  will  overcome 
the  condition. 

Diet  for  Infants.  Milk  sterilized,  oatmeal  water 
and  barley  water. 

For  older  Children.  Fats  and  proteids  should 
form  the  basis  of  the  diet.  Cream,  bacon  occasion- 
ally, stale  bread,  scraped  beef  and  fruits.  Avoid 
starches  and  sugars. 


RECTUM — DISEASES    OF. 

Treatment.  Control  function  and  nutrition  of 
the  rectum  in  the  lumbar  region  through  the  pudic 
nerve;  also  in  middle  sacral  region.  The  rec- 
tum may  be  treated  thi-ough  the  ischio-rectal 
fossa.  Always  examine  the  liver,  as  portal  stag- 
nation mav  be  a  cause. 


151 

RHKUMATISM. 

Laion.  Referred,  it  may  be  at  any  point  in 
the  body.  Primary  lesion  in  liver  or  kidney  regions 
of  the  spine. 

Treatment.  The  liver,  kidneys  and  intestines 
are  three  points  of  attack.  In  case  of  arthritis,  the 
joints  must  be  manipulated  at  each  treatment.  Cor- 
rect the  spinal  lesions  and  separate  the  ribs.  Often 
the  ribs  overlying-  the  liver  are  dislocated.  The 
muscles  in  the  vaso-motor  reg-ion  of  spine,  second 
to  eighth  dorsal,  are  invariably  contracted  and 
must  be  released.  Thoroug-h  relaxation  of  the 
scapular  attachments,  tog-ether  with  the  muscles 
overlying-  the  brachial  plexus,  will  relieve  the  arms. 
Steady  pressure  along-  the  course  of  the  median, 
ulnar  and  musculo-spiral  nerves  in  the  arm,  and 
over  the  anterior  crural,  sciatic  and  oblurator 
nerves  in  the  leg-  relieves  pain  and  stiffness. 

Treat  the  liver  and  kidneys.  In  acute  or  articu- 
lar rheumatism  the  utmost  care  must  be  used. 
The  kidneys  and  the  liver  must  be  treated  as  in 
the  above.  Two  or  three  treatments  should  be 
g-iven  per  day. 

Diet.  Soups,  broths  and  farinaceous  foods, 
lish,  eg-g-s  and  fowl  in  small  quantities.  In  chronic 
cases  meats  in  small  quantities  may  be  allowed. 
Acid  waters,  as  dilute  lemonade,  may  be  adminis- 
tered. Plain  water  in  abundance  is  just  as  effica- 
cious. Fats  are  indicated,  should  arthritis  be  man- 
ifest. 


152 
Prognosis.     Favorable  in  all  recent  cases. 


SCIATICA. 

Lesion.  In  lumbar  region,  usually  lateral.  Some- 
times due  to  muscular  contractions  around  sacro- 
sciatic  notch.  There  is  often  a  sacro-iliac  slip. 

Treatment.  Thoroug-hly  relax  all  muscles  in 
lumbar  region.  After  relaxing-  structures  around 
sacro-sciatic  notch  stretch  the  pyriformis  muscle 
by  rotating-  the  thig-h  inward.  To  do  this,  flex  the 
leg-  on  the  thig-h  and  grasp  the  ankle.  Hold  the 
knee  and  turn  the  leg-  so  as  to  rotate  the  thig-h. 
Flex  thig-h  on  abdomen  and  leg-  on  thig-h,  keeping- 
the  thig-h  flexed,  straig-hten  the  leg-.  This  stretches 
the  sciatic.  Treat  in  popliteal  space  and  at  saph- 
enous  opening-.  Liver  and  kidneys  are  important. 
These  treatments  are  paliative.  The  lesions  in 
the  lumbar  vertebrae  or  at  the  sarcum  must  be 
corrected. 

Diet.     Same  as  in  rheumatism. 

Prognosis.     Very  favorable. 


SCROFULA. 

Lesion.  Since  this  is  tuberculosis  of  the  lym- 
phatic g-lands,  the  location  of  the  lesion  will  vary 
with  the  location  of  the  disease.  The  g-lands  of  the 
neck  and  axilla  are  controlled  by  nerves  from  the 
upper  dorsal  and  cervical  regions.  The  groin  and 
limb  by  middle  ,dorsal  to  lumbar  (vaso-motor). 
The  ribs  are  frequently  at  fault. 


153 

Treatment.  Correct  the  usual  vertebral  lesion. 
Occasionally  a  rib  is  at  fault.  A  general  treatment 
is  given  here.  Exercise,  outdoor  life  and  nourish- 
ing- foods  are  indicated.  Avoid  pork 


SPASMS. 

Lesion.  Is  near  exit  of  nerve  to  muscle  affected. 
For  cranial  nerves  it  is  in  cervical  or  upper  dorsal 
regions.  Sometimes  caused  by  improper  nourish- 
ment to  nerve — disturbance  in  its  vaso-motors. 

Treatment.  Thorough  manipulation  of  limb  af- 
fected will  give  relief  usually.  Steady  pressure 
along  course  of  the  nerve  will  stop  the  spasm. 
Effective  treatment  will  be  to  correct  the  osseous 
lesion. 


SPLEEN TREATMENT    OF. 

The  lesion  is  usually  at  the  eighth  to  tenth  ver- 
tebrae or  else  at  the  ninth  or  tenth  rib  on  left  side. 

Treatment  is  applied  by  manipulation  in  spinal 
region  and  by  flexing  the  limbs  on  abdomen  and 
treating  the  spleen  beneath  the  costal  margin. 
Thorough  vibration  over  ninth  rib  on  left  side 
changes  circulation  through  spleen.  In  case  of 
splenitis,  heat  is  applied.  The  liver  should  always 
be  treated  with  the  spleen,  as  the  venous  drainage 
is  via  liver. 


SUNSTROKE. 

Lesion.      In  sunstroke  or   heat   exhaustion    the 
reflex  lesion  is  a  tensely  drawn  condition  of  the 


154 

muscles  from  the  sixth  dorsal  upward.  These 
must  be  relaxed  as  soon  as  patient  has  been  re- 
moved to  a  cool  place.  If  the  temperature  is  high, 
as  in  thermic  fever,  use  the  ice  pack,  the  bath,  ice 
water  enema,  ice  cap,  etc.  In  heat  exhaustion 
when  temperature  is  sub-normal  the  hot  bath  must 
be  used.  Do  not  omit  the  hydro->therapy. 

TONSILLITIS— QUINSY. 

Lesion.  The  muscles  of  neck  always  tensely 
contracted;  usually  a  primary  lesion  in  middle  or 
upper  cervical  region;  this  is  always  present  in 
chronic  cases. 

Treatment.  In  acute  cases  the  manipulation 
must  be  gently  applied  to  all  muscles  of  neck 
Quietly  apply  pressure  to  the  swollen  tonsils  until 
they  have  been  reduced.  Dip  the  fingers  in  cold 
water  and  press  upon  the  tonsils  and  palate 
internally.  The  cold  water  prevents  gagging.  A 
cold  compress  is  useful.  In  case  of  suppuration  a 
gargle  of  listerine,  1:3,  or  a  spray,  1:2,  is  advised. 
In  acute  cases  treat  several  times  per  day.  In 
chronic  cases  the  lesion  in  the  vertebra  must  be 
corrected  and  the  connective  tissue  removed  by  a 
natural  process  of  absorption.  This  will  follow 
when  the  circulation  is  equalized. 

Diet.  In  advanced  cases  a  liquid  diet  is  neces- 
sary. Sometimes  swallowing  is  impossible.  A 
small  ice  bag  to  suck  \\ill  relieve  thirst  and  allay 
the  pain.  Rectal  alimentation  is  rarely  required. 


155 

Prognosis.     Very  favorable.     If  taken  early,  the 
case  need  not  be  serious. 


TUMORS. 

Lesion.  Can  be  found  in  the  spinal  region  con- 
trolling' the  region  either  in  its  innervation  or  its 
blood  supply.  Osteopathic  practice  proves  that 
most  tumors  are  caused  by  nervous  irritation  and 
imperfect  drainage.  Should  the  tumor  be  of  the 
breast,  the  lesion  is  found  in  the  ribs  of  that  side 
or  in  the  lower  cervical  region.  Should  the  tumor 
be  uterine,  the  lesion  may  be  either  lumbar,  sacro- 
iliac,  or  hyperaemia  of  the  pelvic  organs  may  result 
from  an  imperfect  support  of  the  abdominal  organs. 
In  many  of  these  tumors  a  restoration  of  the  normal 
condition  of  blood  supply  and  drainage  is  effective. 
Do  not  manipulate  the  tumor  itself  very  much,  as 
irritation  may  follow. 

Prognosis.  Each  case  is  a  law  unto  itself.  The 
progress  of  the  case  and  condition  of  the  patient 
must  be  considered.  Many  cases  are  helped,  some 
are  cured,  some  are  not  affected. 


TYPHOID  FKVP:R. 

Lesion.  Very  likely  the  lesions  are  secondary 
only — a  reflex  of  intestinal  disturbance. 

Treatment.  The  usual  hydro-therapy  treatment 
and  nursing  are  important  factors  in  the  care  of 
typhoid  patients.  The  bowels  should  be  kept  in  a 


156 

natural  condition  by  thorough  relaxation  of  the 
splanchnic  and  lumbar  area  twice  each  day.  The 
cerebral  symptoms  are  prevented  or  allayed  by 
treatment  in  the  upper  dorsal  and  cervical  regions. 
The  fever  can  be  controlled  by  cool  spongings  in 
some  cases,  in  others  it  is  necessary  to  use  the 
bath.  This  treatment  will  not  avert  the  disease, 
but  it  will  lighten  all  symptoms.  Gentle  manipu- 
lation of  the  abdomen  and  pressure  over  the  solar 
and  hypo-gastric  plexuses  will  prevent  the  tympan- 
itis if  begun  early.  Holding  the  sub-occipital  region 
will  relieve  the  headache.  Relax  the  entire  spine. 


TORTICOLLIS — WRY   NKCK. 

Lesion.  In  middle  cervical  region  usually,  may 
be  at  the  atlas  or  even  in  lower  region.  It  is  a  type 
of  muscular  rheumatism. 

Treatment.  Put  hand  on  sterno-cleido  mastoid 
muscle  at  a  point  of  entrance  of  the  eleventh  nerve. 
Turn  the  neck  as  far  as  possible  each  way.  Put- 
ting the  neck  on  tension  by  bending  it  and  suddenly 
rotating  the  head  in  that  same  direction  will  usually 
overcome  the  condition. 

Prognosis.  Good  in  all  recent  cases.  In  some 
cases  of  long  standing  nothing  can  be  done. 

VOMITING. 

In  most  cases  of  vomiting  the  lesion  is  located  in 
the  middle  and  upper  dorsal  region  usually  at  the 


157 

third  to  fifth  ribs.  Elevation  of  these  ribs,  steady 
pressure  at  their  angles  and  a  thorough  relaxation 
of  the  intercostal  muscles  will  stop  the  paroxysms. 
This  will  usually  stop  vomiting-  in  "morning-  sick- 
ness." 

VASOMOTOR    DISTURBANCES. 

In  vaso-motor  disturbances  the  heart,  the  eyes, 
the  stomach  and  the  vaso-motors  are  closely  con- 
nected. If  the  disturbance  is  from  the  vaso-motors 
look  for  lesion  in  the  upper  dorsal  region,  usually 
from  second  to  sixth  dorsal.  Again  the  lesion  may 
be  in  the  lower  cervical  region  affecting  the  middle 
or  inferior  cervical  plexus. 

Treatment.  Correction  of  the  lesion.  Treat- 
ment of  the  stomach,  thorough  relaxation  and 
stretching  of  neck  will  usually  bring  about  the 
desired  result. 


GYNECOLOGY. 


Our  race  is  entitled  to  a  healthier  motherhood. 
In  eliminating-  drug's  and  substituting-  a  rational 
method  of  treatment,  Osteopathy  has  contributed 
much  to  this  end.  In  pelvic,  even  more  prominently 
than  in  other  diseases,  is  the  rationale  si  osteopathic 
treatment  broug-ht  into  view. 

Take  off  the  pressure.  Remove  the  stasis. 
Replace  and  strengthen  the  org-ans.  Nature  will 
restore  health  and  vitality  if  she  have  the  oppor- 
tunity. No  matter  what  condition  the  disease  of 
the  pelvic  org-ans  may  have  assumed,  there  is  too 
much  blood  there,  for  continued  over-stimulation 
of  the  vaso-constrictors  would  soon  result  in  a 
weakness  of  both  nerves  and  vascular  walls  and  a 
consequent  eng-org-ement.  Always  too  much  blood 
— hyperaemia.  This  results  in  a  stasis,  but  still 
too  much  blood.  Moving-  blood  is  health.  Stasis 
reduces  the  nutritive  properties  of  the  blood,  in- 
creases its  percentag-e  of  waste  products,  deterio- 


rates  the  vascular  walls  and  produces  transudation 
and  oedema. 

This  increase  of  local  fluid  is  an  irritant  to  the 
nerve  ending's  and  the  org-ans  are  excited  to  a  con- 
dition of  pain.  This  condition  now  results  in  a 
morbid  metabolism,  either  constructive  as  growths, 
enlargements,  and  tumors;  or  to  breaking-  down  of 
tissue  throug-h  retrograde  metabolism,  as  in  ulcer- 
ations. 

In  almost  all  cases  of  pelvic  disturbances  leucor- 
rhoea  is  a  preceding-  condition,  an  unmistakable  sign 
of  hyperaemia,  venous  stasis,  and  decreased  vitality 
of  vascular  walls.  This  fluid  should  be  returned 
by  nature's  conduits,  the  veins,  designed  to  carry 
back  the  products  of  oxidation  in  the  tissues.  If 
there  be  pressure  on  the  venous  channels  anywhere 
between  pelvis  and  heart  then  will  this  exudation 
be  present.  But  this  pressure  to  the  veins  is  not 
the  only  factor  which  may  disturb  the  vitality  of  the 
pelvic  org-ans.  Closely  related  as  they  are  with  the 
sympathetic  nervous  system  and  with  the  cerebro- 
spinal,  both  directly  and  indirectly,  the  pelvic 
org-ans  are  the  servants  of  the  nervous  system. 
Any  chang-e  in  their  positions  may  irritate  an  affer- 
ent nerve  and  reflexly  interfere  with  their  nutrition 
and  function. 

But  this  is  not  all.  Any  chang-e  that  may  occur 
along-  the  pathway  of  these  nerves  will  produce  the 
same  effect.  The  pelvic  org-ans  are  innervated  by 


the  nerves  making-  their  exit  from  the  lumbar  and 
from  the  sacral  portions  of  the  spinal  canal,  and 
from  the  hypogastric  plexus  lying1  over  the  body  of 
the  fifth  lumbar  vertebra. 

The  nerves  to  the  ovary  come  from  the  uterus 
along-  the  Fallopian  tubes  while  another  pathway  is 
from  the  ovarian  plexus,  derived  from  the  aortic 
plexus,  thus  related  to  the  lower  portion  of  the 
solar  plexus.  The  hypogastric  plexus  also  receives 
fibres  from  the  lower  dorsal,  thus  connecting  these 
organs  with  the  lower  dorsal  and  upper  lumbar 
spinal  segments. 

The  arterial  supply  to  the  pelvic  viscera  is  from 
the  aorta  via  the  ovarian  and  from  the  internal  iliac 
via  the  uterine,  drainage  being-  effected  into  corres- 
ponding veins. 

In  position  the  uterus  extends  from  the  fundus, 
a  little  below  the  brim  of  the  pelvis,  slig-htly  to  the 
right  of  the  middle  line,  to  the  upper  portion  of  the 
vagina,  into  which  the  cervix  projects,  meeting  it 
normally  at  a  right  angle  or  greater.  The  condition 
of  the  bladder  and  rectum  will  affect  the  position  of 
this  organ. 

The  Fallopian  tubes  extend  laterally  from  the 
superior  angles  of  the  uterus,  lying  below  the  level 
of  the  sacral  promontory,  enwrapped  in  the  broad 
ligament.  They  are  from  three  to  five  inches  in 
length,  lying  over  and  around  the  ovaries.  The 
latter  bodies  are  about  one  and  one-half  inches  long, 


ne  inch  broad  and  one-half  inch  thick,  and  lie  in  the 
broad  ligament.  They  lie  just  within  the  true 
pelvis  at  the  side  of  the  uterus  and  cannot  normally 
be  palpated  through  the  abdominal  wall.  Their 
blood  supply  is  derived  from  the  ovarian  artery, 
their  nerves  from  the  hypogastric  plexus. 

Examination  of  the  pelvic  organs  can  be  made  in 
many  cases  and  cures  be  affected  without  a  vaginal 
examination.  This  is  often  true  in  cases  of  young 
girls.  The  examination  should  first  be  directed  to 
the  spine  in  the  following  regions:  The  ninth  to 
eleventh  dorsal,  the  first  to  third  lumbar,  the  lumbo- 
sacral  articulation,  the  sacro-iliac  synchondroses 
and  the  second  and  third  sacral  nerves. 

In  addition,  the  fifth  lumbar  is  almost  invariably 
affected,  either  primarily  disturbing  the  hypogas- 
tric  plexus  or  reflexly  from  it. 

For  a  local  examination  the  patient  should  be  on 
her  back,  the  legs  flexed.  The  body  of  the  patient 
should  be  covered.  For  examination  the  hand 
should  be  carefully  cleaned  and  rendered  aseptic, 
and  slightly  coated  with  some  non-irritating  sub- 
stance. Should  it  become  necessary  to  examine  a 
virgin  the  greatest  care  must  be  taken  to  avoid 
rupturing  the  hymen.  Often  an  imperforate  hymen 
may  be  the  cause  of  trouble. 

The  left  hand  should  be  used  to  depress  the 
uterus  through  the  anterior  abdominal  wall.  Care- 
fully notice  the  position  of  the  uterus.  In  ordinary 


cases  the  index  finger  should,  without  force,  reach 
the  uterus  as  it  extends  into  the  vagina.  Should  it 
be  too  close  to  the  vaginal  entrance  there  is  prolapse. 
The  direction  of  the  os  and  cervix  will  determine 
whether  the  uterus  is  tipped  anteriorly,  posteriorly 
or  laterally;  called  ante-version,  retro-version  and 
latero-version. 

Should  the  fundus  be  bent  upon  the  cervix  the 
corresponding-  flexion  prevails.  An  examination 
with  speculum  and  sound  is  often  necessary. 

Should  any  of  these  conditions  be  present  it  is 
an  indication  of  the  presence  of  too  much  blood  of 
an  inferior  quality.  Pain  and  irritation  have  called 
too  much  blood  to  the  parts;  stasis  has  caused  its 
quality  to  deteriorate.  Local  applications  are  use- 
less. Pessaries  and  supports  are  in  no  sense  cor- 
rectives The  treatment  consists  in  correcting-  the 
disturbances  in  some  of  the  following-  locations: 
The  muscles,  ligaments  and  vertebrae  in  the  lower 
dorsal  and  lumbar  regions  should  be  made  normal. 
An  impacted  sigmoid  and  rectum  may  cause  trouble 
to  the  uterus  itself  or  to  the  hypogastric  plexus. 
Overcome  constipation  and  in  many  cases  the  cure 
is  effected.  Remove  the  pressure  of  the  abdominal 
viscera,  prevent  lacing,  cause  patient  to  stand  and 
sit  with  spine  straight,  thorax  forward  and  abdo- 
men drawn  backward.  Control  of  the  lower  portion 
of  the  abdominal  parietes  so  as  to  exert  a  constant 
lifting  force  on  the  abdominal  contents  will  prevent 


many  diseases  and  overcome  the  incipient  stages 
of  all. 

The  pudic  nerve  should  be  stimulated  as  it  passes 
over  the  spine  of  the  ischium.  This  nerve  supplies 
most  of  the  perineal  muscles.  By  maintaining-  their 
tonic  condition  the  vaginal  walls  are  supported,  thus 
keeping-  the  uterus  in  place.  Relaxation  of  the 
perineum  tends  toward  prolapsus. 

Good  effects  are  secured  by  drawing-  upward  the 
pelvic  portion  of  the  abdominal  wall.  This  is  done 
while  the  patient  is  lying-  on  her  back,  the  leg's 
flexed;  or  by  drawing-  the  viscera  forward,  the 
patient  occupying-  the  g-enu-pectoral  position.  Ordi- 
nary cases  of  displacements  may  be  cured  by  the 
preceding-  movements.  A  very  efficient  treatment 
for  misplacement  is  to  insert  two  fingers  into  the 
vagina,  the  patient  in  the  g-enu-pectoral  position, 
the  abdominal  viscera  pushed  forward,  then  spread 
the  fing-ers  so  as  to  admit  air  to  the  vagina.  The 
pressure  of  the  atmosphere  will  usually  replace  the 
uterus.  The  patient  should  remain  quiet  for  some 
time  after  the  treatment.  Stimulation  of  the  round 
lig-ament  is  useful  should  there  be  retro-flexion  or 
retro-version. 

Coccyg-odinea  should  be  treated  by  removing-  any 
irritation  to  the  coccyg-eal  nerve  and  by  quieting- 
the  coccyg-eal  giand.  A  dislocated  coccyx  may  give 
much  trouble  of  this  nature. 

Metritis  is  treated  throug-h  the  lumbar  nerves 


and  the  hypog-astric  plexus.  The  pudic  nerve  is 
always  to  be  treated  in  cases  involving-  the  vaginal 
walls. 

Ovaritis  is  often  relieved  at  the  lower  dorsal  or 
first  lumbar  through  correction  of  osseous  disloca- 
tion. Dysmenorrhoea  can  be  relieved  and  cured  by 
correction  of  these  lumbar  and  lower  dorsal  verte- 
bra, and  the  sacro-iliac  synchondrosis,  tog-ether 
with  the  correction  of  any  uterine  displacement. 
Amenorrhoea  is  relieved  by  building-  up  the  respir- 
atory, circulatory  and  alimentary  systems;  by 
spreading-  the  lumbar  vertebrae  with  a  "figure  of 
eig-ht "  motion;  and  in  addition  by  striking-  your  left 
hand,  laid  across  the  patient's  sacrum,  sharply  with 
your  rig-ht  closed  fist.  This  is  a  powerful  stimulant. 


PAGE 

Acne    38 

Ague 40 

Anemia .            .  4 » 

Angina  pecvns             41 

Annulus  of  Vieussens 24 

Appendicitis            42 

Apoplexy.                44 

Arm,  vaso- motors  to 24 

Arthritis                   45 

Ascites     46 

Asthma 48 

Ataxia  locomotor 49 

Atlas                             ..            ....  22 

Atrophy,  progressive  muscular  50 

Axis 22 

Biliary  calculi                58 

Bladder,  center  for 26 

Bladder  troubles 57 

Boils                          52 

Brady  cardia 56 

Brain  troubles        ...          52 

Bright's  disease 53 

Bronchi,  center  for.   25 

Bronchitis             56 

Calculi,  biliary 58 

Calculi,  renal 60 

Cardiac  troubles  61 

Cataract. 61 

Catarrh 62 

Centers,  Osteopathic 20-32 

Center,  definition  of 22 

Chickenpox 64 

Chills,  center  for 25 

Chills                        40 

Cholera  infantum    65 

Cholera  morbus 66 

Chorea...            ..  66 

Cirrhosis  of  liver 68 

Coryza    62-69 

Cold 69 

Colon,  center  for 29 

Constipation 69-72 

Consumption 72 

Convulsions 73 

Cough               74 

Croup    76 

Curvatures           77 

Curvature,  anterior 78 

Curvature,  lateral       81 

Curvature,  posterior  80 

Curves  of  spine 12 

Deafness 89 

Dementia    82 

Diabetes 82 


PAGE 

Diarrhoea, 84 

Diarrhoea,  center  for 25 

Diphtheria 77,85 

Dizziness 88 

Duodenum 28 

Dysentery 85 

Dyspepsia 86 

Ear         28,89 

Eczema    89 

Emphysema 92 

Endocarditis  92 

Enteralgia 93 

Enteritis 94 

Epilepsy 94 

Erysipelas % 

Epistaxis         97 

Examination,  Osteopathic     ..11-20 

Examination,  positions  for 16 

Exophthalmic  goitre 97 

Eve  98 

Eye,  center  for 22,  28 

Femur,  dislocation  of 113 

Fever 100 

Fever,  hay 108 

Fever,  intermittent 40 

Fever,  scarlet 101 

Gallstones     58 

Gastritis 104 

Goitre,  exophthalmic 97 

Goitre 104 

Gripes    93 

Grippe 121 

Hsematemesis.  105 

Haematuria 105 

Haemoptoysis 105 

Haemorrhoids 106 

Hay  fever 108 

Headache  . 108 

Hemicrania 109 

Hemiplegia 110 

Herpes  112 

Hiccough  .  112 

Hip,  dislocation  of 113 

Hives 112 

Hyperaemia 112: 

Hysteria   life 

Icterus 116 

Ileum 28 

Ilium,  dislocation  of 117 

Incontinence  of  urine    120 

Infantile  paralysis 120 

Influenza 121 


PAGE 

Insanity •    .  •   121 

Insomnia 122 

Jaundice 116 

Jejunum 28 

Kidney,  center  for — 26 

Kidney,  treatment  of 124 

Kyphosis 80-125 

Kyphosis,  treatment  of 125 

La  grippe 124 

Larynxj  center  for, 28 

Laryngitis 

Leukemia.   126 

Lithaemia  128 

Liver,  arrhesis  for 68 

Liver,  center  for 25 

Liver  spots 129 

Liver,  treatment  for 128 

Lordosis ; 78, 129 

Lumbago    130 

Lungs,  treatment  of 130 

Lnngs,  vaso-constrictors 24 

Malaria 40 

Measles 132 

Melancholia   133 

Micturition,  center  for 25 

Migraine 109, 133 

Mumps    133-145 

Muscular  rheumatism,  myalgia  134 
Myocarditis 136 

Nerves,  spinal  origin  of  20 

Neuralgia 136 

Neurasthenia 137 

Neuritis 140 

Neuroses,  occupation 138 

Neuroses,  traumatic 138 

Obesity 140 

Obstetrics  140-144 

Palpitation 144 

Pancreas,  treatment  of 145 

Paralysis  145 

Paralysis,  infantile 133 

Parotitis, 120 

Pericarditis 146 

Peritonitis 146 

Pertussis 146 

Pharyngitis 147 


PAGE 

Pharynx,  center  for 22-28 

Phrenics,  origin  of 22 

Phthisis,  pulmonary...  72 

Piles 106 

Pleurisy 147 

Pneumonia 143 

Poly  nria ' ' ' ' '  149 

Potts' disease ..  149 

Pyetitis 150 

Pyrexia .  [..   100 

Quinsy 154 

Rachitis.                      150 

Rectum,  center  for  .   .     29 

Rectum,  diseases  of 150 

Renal  calculi 60 

Ribs,  setting 36,37 

Rickets 150 

Rheumatism "..',  151 

Rhinitis 62 

Sciatica 153 

Scoliosis 81 

Scrofula 153 

Spasms 153 

Spines,  levels  of 17-18 

Spleen,  center  for 24-25 

Spleen,  treatm  ent  of 153 

Stomach,  center  for 24-25 

St.  Vitus  dance 66 

Sunstroke    

Tabes  dorsal  is 49 

Thyroid  gland 24 

Tonsilitis 154 

Tonsils,  center  for 28 

Tormina  93 

Torticollis 156 

Tuberculosis  of  lungs 72 

Tumors  .  155 

Typhoid  fever 155 

Uterus,  center  for 25-29 

Urticaria. 112 

Vagina,  center  for 26 

Vaso-motors 157 

Vomiting,  center  for 24 

Vomiting,  treatment  for 156 

Whooping  cough 146 


2  WKS  FROM  RECEIPT 

SEP  2  5  2000 
U.C.'S 


PB.NTED   IN   U.S.A.  CAT.      NO.     24      161 


31970016238195 


WB9UO 
R569m 
1901 
Riggs,  Wilfred  L. 

Manual  of  osteopath! c  manipu- 
lations and  treatment 


1901 

Riggs,  Wilfred  L. 

Manual  of  osteopathic  manipulations 
and  treatment 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 
IRVINE,  CALIFORNIA  92664 


